Makaloski Vladimir, von Deimling Christian, Mordasini Pasquale, Gralla Jan, Do Dai-Do, Schmidli Juerg, Wyss Thomas R
Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Ann Vasc Surg. 2017 Aug;43:242-248. doi: 10.1016/j.avsg.2017.02.009. Epub 2017 May 3.
To evaluate the hybrid treatment of severe stenosis or occlusion of the proximal innominate artery (IA) and common carotid artery (CCA) via surgical cutdown of the CCA and distal clamping for cerebral protection against thromboembolic events during retrograde stenting.
Consecutive patients undergoing retrograde stenting of proximal IA and CCA stenosis or occlusion via surgical cutdown of the CCA and with distal clamping for prevention of embolization, with or without concomitant endarterectomy of the carotid bifurcation, between April 1999 and August 2015 were reviewed. Perioperative and long-term outcomes were assessed.
Thirty-five patients underwent a total of 36 successful interventions. One patient underwent staged bilateral stenting. Additional concomitant carotid endarterectomy was performed in 13 patients (36%). No new neurological symptoms neither perioperatively nor in-hospital were recorded. Thirty-day follow-up revealed 1 new ipsilateral and 1 new contralateral stroke (6%) with completely patent stents, no reinterventions, and 2 unrelated deaths (6%). Median follow-up was 56 months (range: 1-197). After 5 and 10 years, the Kaplan-Meier estimated overall survival rate was 85% and 52%. Primary assisted patency rate was 94% during follow-up. Overall freedom from reintervention was 91%. Three reinterventions were performed during the first postoperative year. Three new neurological events occurred during follow-up, 1 ipsilateral (3%) and 2 contralateral (6%). The ipsilateral event occurred during the first year and both contralateral events during the second year postoperatively.
The retrograde hybrid approach to proximal IA and CCA disease is a safe procedure with surgical outflow control preventing perioperative stroke in ipsilateral carotid territory. Most relevant in-stent stenoses/occlusions and new neurological events occurred within the first 2 years, suggesting these patients should undergo regular monitoring early postoperatively. High patency rates without further neurological events can be expected thereafter.
评估通过切开颈总动脉及远端阻断以保护大脑免受逆行支架置入术中血栓栓塞事件影响，对无名动脉近端（IA）和颈总动脉（CCA）严重狭窄或闭塞进行的杂交治疗。
回顾了1999年4月至2015年8月期间，通过切开颈总动脉并远端阻断以预防栓塞，无论是否同时行颈动脉分叉内膜切除术，对IA和CCA近端狭窄或闭塞进行逆行支架置入术的连续患者。评估围手术期和长期结果。
35例患者共进行了36次成功干预。1例患者接受了分期双侧支架置入术。13例患者（36%）同时进行了颈动脉内膜切除术。围手术期和住院期间均未记录到新的神经系统症状。30天随访显示，有1例新的同侧和1例新的对侧卒中（6%），支架完全通畅，无再次干预，2例无关死亡（6%）。中位随访时间为56个月（范围：1 - 197个月）。5年和10年后，Kaplan-Meier估计的总生存率分别为85%和52%。随访期间主要辅助通畅率为94%。总体免于再次干预率为91%。术后第一年进行了3次再次干预。随访期间发生了3例新的神经系统事件，1例同侧（3%）和2例对侧（6%）。同侧事件发生在术后第一年，2例对侧事件均发生在术后第二年。
对IA和CCA近端疾病的逆行杂交方法是一种安全的手术，通过手术控制血流可预防同侧颈动脉区域的围手术期卒中。大多数相关的支架内狭窄/闭塞和新的神经系统事件发生在术后2年内，提示这些患者术后早期应接受定期监测。此后可预期有较高的通畅率且无进一步的神经系统事件。
