Spiotta Alejandro M, Vargas Jan, Zuckerman Scott, Mokin Maxim, Ahmed Azam, Mocco J, Turner Raymond D, Turk Aquilla S, Chaudry M Imran, Myers Phil
*Division of Neurosurgery, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina; ‡Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee; §Department of Neurosurgery, University of South Florida, Tampa, Florida; ¶Department of Neurosurgery, University of Wisconsin School of Medicine, Madison, Wisconsin; ‖Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina; and #Department of Neurosurgery, Columbia University, New York, New York.
Neurosurgery. 2015 Apr;76(4):403-10. doi: 10.1227/NEU.0000000000000642.
Stroke in the immediate postoperative period after carotid endarterectomy is a rare complication. Many centers have begun incorporating angiography before surgical re-exploration, which has the advantage of confirming carotid occlusion and treating tandem intracranial lesions if present.
To determine the safety and efficacy of this strategy.
A retrospective review was performed of all patients undergoing acute stenting of the carotid artery after carotid endarterectomy from November 2009 to June 2013 at 4 centers. Charts and angiographic images were reviewed. Eleven cases of carotid thrombosis within 72 hours of carotid endarterectomy and subsequent treatment strategies are summarized.
All patients had >50% carotid stenosis before carotid endarterectomy. One patient had intraoperative occlusion and dissection of the internal carotid artery, which was noted on intraoperative carotid duplex ultrasound. All patients underwent postoperative computed tomography or computed tomography perfusion scans with subsequent cerebral angiography and stent reconstruction within 11 hours of symptom onset. In all cases, carotid recanalization was successfully completed between 32 and 160 minutes from groin puncture. There were no procedural complications. Four patients had a tandem middle cerebral artery occlusion, 3 of whom underwent successful recanalization.
Emergent endovascular evaluation in the setting of acute post--carotid endarterectomy thrombosis is a safe and timely treatment option, with the benefit of detecting and treating embolic intracranial lesions. Immediate angiography and intervention in this rare surgical complication show promising initial results.
颈动脉内膜切除术后即刻发生的中风是一种罕见的并发症。许多中心已开始在再次手术探查前进行血管造影，其优点是可确认颈动脉闭塞情况，并在存在串联颅内病变时进行治疗。
确定该策略的安全性和有效性。
对2009年11月至2013年6月在4个中心接受颈动脉内膜切除术后急性颈动脉支架置入术的所有患者进行回顾性研究。查阅病历和血管造影图像。总结了11例颈动脉内膜切除术后72小时内发生颈动脉血栓形成及后续治疗策略。
所有患者在颈动脉内膜切除术前均有>50%的颈动脉狭窄。1例患者术中出现颈内动脉闭塞和夹层，术中颈动脉双功超声检查发现。所有患者在症状发作后11小时内接受了术后计算机断层扫描或计算机断层扫描灌注扫描，随后进行脑血管造影和支架重建。在所有病例中，从腹股沟穿刺开始，32至160分钟内成功完成了颈动脉再通。无手术并发症。4例患者出现串联大脑中动脉闭塞，其中3例成功再通。
在急性颈动脉内膜切除术后血栓形成的情况下进行紧急血管内评估是一种安全、及时的治疗选择，有利于检测和治疗栓塞性颅内病变。对这种罕见手术并发症进行即刻血管造影和干预显示出有希望的初步结果。
