Department of Vascular Surgery, Room G04.129, University Medical Centre Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
J Neurol. 2018 Aug;265(8):1900-1905. doi: 10.1007/s00415-018-8939-z. Epub 2018 Jun 18.
Near occlusion (NO) of the internal carotid artery (ICA) with full collapse (NOFC) is a rare condition, with a prevalence of around 1%. Guidelines on carotid stenosis recommend a conservative treatment in patients with a single-event ipsilateral to a NOFC, but the optimal treatment for patients with recurrent symptoms associated with NOFC remains uncertain. We describe a consecutive series of patients with recurrent symptoms associated with NOFC (RSNOFC) who underwent carotid endarterectomy (CEA).
From 2008 to 2017, 17 consecutive patients with RSNOFC were treated according to our standardized multidisciplinary work-up and protocol and included for this single-center cohort study. NO was defined according to the angiographic North American Symptomatic Carotid Endarterectomy Trial criteria. Only patients with NOFC were included in this study.
Standard longitudinal CEA was performed in 15 patients, whereas in 2 patients the ICA was ligated with concomitant endarterectomy of the ECA. Within 30 postoperative days, one patient died from a hemorrhagic infarction. During follow-up (median 23 months) one patient died of unknown cause 90 days after CEA. No TIA, stroke, myocardial infarction or re-stenosis occurred in the remaining patients.
In patients with RSNOFC, CEA may be considered a potential treatment option. Although procedural risks in this small subgroup may be higher as compared to patients with low-to-moderate risk anatomy, this risk may outbalance the natural course.
颈内动脉（ICA）接近闭塞（NO）伴完全塌陷（NOFC）是一种罕见的情况，其患病率约为 1%。颈动脉狭窄指南建议对单侧单一事件伴发 NOFC 的患者进行保守治疗，但对于伴发 NOFC 相关反复发作症状患者的最佳治疗方法仍不确定。我们描述了一组连续的、伴发 NOFC（RSNOFC）的、反复发作症状患者，他们接受了颈动脉内膜切除术（CEA）。
2008 年至 2017 年，17 例连续的 RSNOFC 患者根据我们的标准化多学科评估和方案进行治疗，并包括在此单中心队列研究中。NO 根据血管造影北美症状性颈动脉内膜切除术试验（North American Symptomatic Carotid Endarterectomy Trial）标准定义。只有伴发 NOFC 的患者才被纳入本研究。
15 例患者进行了标准的纵向 CEA，2 例患者同时结扎 ICA 并进行 ECA 内膜切除术。术后 30 天内，1 例患者死于出血性梗死。在随访期间（中位数 23 个月），1 例患者在 CEA 后 90 天死于不明原因。其余患者均未发生 TIA、中风、心肌梗死或再狭窄。
在 RSNOFC 患者中，CEA 可能被视为一种潜在的治疗选择。尽管与低至中度风险解剖结构的患者相比，该小亚组的手术风险可能更高，但这种风险可能超过自然病程。
