Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
J Vasc Surg. 2018 May;67(5):1429-1437. doi: 10.1016/j.jvs.2017.08.093. Epub 2017 Dec 8.
The objective of this study was to investigate and to compare the early and long-term results of open surgery with endovascular intervention in the treatment of extracranial carotid artery aneurysms (ECCAs).
A retrospective review of patients diagnosed with ECCAs who underwent open surgical or endovascular treatment from 1997 to 2017 was performed. Clinical characteristics, aneurysm profile, and treatment outcomes were recorded. Early results (<30 days) were evaluated in terms of mortality, perioperative stroke or transient ischemic attack, and cranial nerve injury. Late results were analyzed in terms of both overall and stroke-free survival and freedom from reinterventions.
A total of 48 patients with ECCAs including 34 (70.8%) true aneurysms and 14 (29.2%) pseudoaneurysms were treated. The median age was 51 years, and 19 patients (39.6%) were men; 41 patients (85.4%) had symptoms, whereas 7 (14.6%) were asymptomatic. Among 48 patients, 32 patients (66.7%) underwent open surgery; endovascular repair was performed on 16 patients (33.3%). The 30-day stroke or transient ischemic attack rate was not significantly different between the open group (6.3% [2/32]) and the endovascular group (0% [0/16]; P = .307). Cranial nerve injuries occurred in eight patients in the open group (25%) and in no patient in the endovascular group (0%; P = .029). Median length of stay was significantly longer in the open group than in the endovascular group (20 vs 14 days, respectively; P = .013). Median follow-up was 46 months (range, 0-20 years), and no aneurysm-related death occurred during this period. Overall survival rates at 5 years were 88.7% (standard error [SE], 0.08) in the open group and 91.7% (SE, 0.08) in the endovascular group (P = .319; log-rank, .992). For the same time interval, stroke-free survival rates were 85.2% (SE, 0.10) in the open group and 92.2% (SE, 0.07) in the endovascular group (P = .653; log-rank, .201). One patient (1/28 [3.6%]) in the open group and two patients (2/16 [12.5%]) in the endovascular group underwent endovascular reinterventions because of restenosis during the follow-up period. Reintervention-free survival rates were 90.9% in the open group (SE, 0.09) and 69.2% in the endovascular group (SE, 0.21; P = .082; log-rank, 3.016).
In this single-institutional experience, both operative and endovascular interventions for ECCAs provided acceptable early and 5-year results. The endovascular approach had significantly less cranial nerve injury and shorter length of hospital stay.
本研究旨在探讨和比较开放手术与血管内介入治疗颅外颈动脉动脉瘤（ECCA）的早期和长期结果。
回顾性分析了 1997 年至 2017 年间接受开放手术或血管内治疗的 ECCA 患者。记录了临床特征、动脉瘤特征和治疗结果。早期结果（<30 天）评估包括死亡率、围手术期卒中或短暂性脑缺血发作以及颅神经损伤。晚期结果分析包括总生存率和无卒中生存率以及免于再次干预的情况。
共纳入 48 例 ECCA 患者，其中 34 例（70.8%）为真性动脉瘤，14 例（29.2%）为假性动脉瘤。中位年龄为 51 岁，19 例患者（39.6%）为男性；41 例患者（85.4%）有症状，7 例（14.6%）无症状。48 例患者中，32 例行开放手术治疗；16 例行血管内修复术。开放组（6.3%[2/32]）与血管内组（0%[0/16]；P=0.307）的 30 天卒中或短暂性脑缺血发作率无显著差异。开放组有 8 例（25%）患者发生颅神经损伤，而血管内组无患者发生（0%；P=0.029）。开放组的中位住院时间明显长于血管内组（分别为 20 天和 14 天；P=0.013）。中位随访时间为 46 个月（0-20 年），在此期间无动脉瘤相关死亡。开放组和血管内组的 5 年总生存率分别为 88.7%（标准误差[SE]，0.08）和 91.7%（SE，0.08）（P=0.319；对数秩检验，P=0.992）。在同一时间间隔内，开放组的无卒中生存率为 85.2%（SE，0.10），血管内组为 92.2%（SE，0.07）（P=0.653；对数秩检验，P=0.201）。开放组有 1 例（1/28 [3.6%]）和血管内组有 2 例（2/16 [12.5%]）患者在随访期间因再狭窄而行血管内再次干预。开放组和血管内组的免于再次干预的生存率分别为 90.9%（SE，0.09）和 69.2%（SE，0.21；P=0.082；对数秩检验，P=3.016）。
在本单中心经验中，开放手术和血管内介入治疗 ECCA 均能获得可接受的早期和 5 年结果。血管内方法的颅神经损伤明显较少，住院时间较短。
