Nordestgaard A G, White G H, Cobb S, Mehringer M, Wilson S E
Department of Surgery, Harbor-UCLA Medical Center, Torrance 90509.
Ann Vasc Surg. 1987 Dec;1(5):610-5. doi: 10.1016/S0890-5096(06)61451-9.
An extensive traumatic intimal dissection of the internal carotid artery was successfully managed by permanent occlusion of the vessel with percutaneously-placed, inflatable balloons in a young patient who had suffered transient ischemic neurological attacks despite anticoagulation. This technique has not been previously reported for treatment of dissection. Review of 34 published reports of symptomatic intimal dissection associated with non-penetrating trauma to the head and neck revealed that most did not have a direct injury to the carotid region and that development of symptoms was often delayed. Only 50% of these patients had onset of neurological symptoms within six hours of the episode of trauma, while 33% remained asymptomatic for more than one week before complications occurred. In 15 patients who were treated surgically, only nine (60%) achieved full recovery. Operative repair was considered unduly hazardous in our patient because of extension of the spiral dissection to the base of the skull. Successful use of percutaneous balloon occlusion of the carotid in this patient suggests that this technique should be considered a worthy alternative for management of selected cases.
一名年轻患者尽管接受了抗凝治疗仍发生短暂性缺血性神经发作，其颈内动脉广泛创伤性内膜剥离通过经皮放置可充气球囊永久性闭塞血管成功处理。此前尚未有该技术用于治疗剥离的报道。回顾34篇已发表的关于头颈部非穿透性创伤相关症状性内膜剥离的报告发现，大多数患者颈动脉区域没有直接损伤，且症状出现往往延迟。这些患者中只有50%在创伤事件后6小时内出现神经症状，而33%在并发症发生前一周多仍无症状。在15例接受手术治疗的患者中，只有9例（60%）完全康复。由于螺旋状剥离延伸至颅底，手术修复在我们的患者中被认为风险过大。该患者成功使用经皮球囊闭塞颈动脉表明，对于某些选定病例，该技术应被视为一种值得考虑的替代方法。
