Samaniego Edgar A, Katzen Barry T, Kreusch Andreas S, Uthoff Heiko
Departamento de Cirugía Neuroendovascular, Hospital Eugenio Espejo, Quito, Ecuador, Fla., USA.
Division of Vascular and Interventional Radiology, Baptist Cardiac and Vascular Institute, Miami, Fla., USA.
Interv Neurol. 2015 Jan;3(1):41-7. doi: 10.1159/000369302.
Tandem atherosclerotic lesions of the carotid bifurcation and the ipsilateral proximal common carotid artery (CCA) or innominate arteries (IA) can be challenging to treat. A surgical approach may treat the lesion at the carotid bifurcation, but proximal CCA or IA lesions require a major surgical exposure. An endovascular approach is challenging as well since anatomic variations, such as a type III aortic arch, can render navigation very difficult. We report our experience in the hybrid surgical and endovascular treatment of complex proximal CCA and IA lesions. Eleven patients who underwent hybrid procedures with surgical exposure (with or without endarterectomy) of the carotid artery and retrograde endovascular intervention of a proximal lesion were included in the study. The mean percentage of stenosis was 81%. Seven patients underwent a carotid endarterectomy (CEA), and 4 patients underwent only a surgical cutdown for retrograde endovascular access of the IA or left CCA. All procedures were technically successful. Eight patients had no symptoms within 30 days of the procedure. The hybrid retrograde endovascular approach through carotid exposure with or without CEA appears to be effective and safe in selected patients who have a high-risk complex anatomy of tandem lesions.
颈动脉分叉处与同侧颈总动脉近端（CCA）或无名动脉（IA）的串联动脉粥样硬化病变的治疗颇具挑战性。手术方法可治疗颈动脉分叉处的病变，但颈总动脉近端或无名动脉病变需要较大的手术显露。血管内治疗方法同样具有挑战性，因为诸如III型主动脉弓等解剖变异会使操作导航变得非常困难。我们报告了我们在复杂的颈总动脉近端和无名动脉病变的杂交手术和血管内治疗方面的经验。本研究纳入了11例接受了颈动脉手术显露（伴或不伴动脉内膜切除术）及近端病变逆行血管内介入的杂交手术患者。平均狭窄百分比为81%。7例患者接受了颈动脉内膜切除术（CEA），4例患者仅进行了手术切开以逆行血管内进入无名动脉或左颈总动脉。所有手术在技术上均获成功。8例患者在术后30天内无症状。对于具有串联病变的高风险复杂解剖结构的特定患者，通过颈动脉显露伴或不伴CEA的杂交逆行血管内治疗方法似乎有效且安全。
