Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100000, China.
Department of Gerontology, The First Hospital of Jilin University, Changchun, Jilin 130021, China.
Biomed Res Int. 2020 Nov 28;2020:6622502. doi: 10.1155/2020/6622502. eCollection 2020.
The optimal treatment choice of chronic carotid artery occlusion (CAO) remains inconclusive. This study was aimed at exploring the safety and effectiveness of hybrid surgery in the treatment of CAO and at determining predictors for successful recanalization.
In this study, we enrolled 37 patients with CAO who underwent hybrid surgical treatment during the period 2016-2018. We extracted and analyzed patients' demographic data, disease characteristics, surgical success rates, perioperative complications, and prognosis.
A total of 37 patients with symptomatic CAO underwent hybrid surgical treatment. Thirty cases (81.1%) were successfully recanalized, while seven were not. Blood reflux after carotid endarterectomy occurred in 18 patients (60%) of the success group and 1 (14.3%) of the failure group (OR, 9.0; 95% CI, 0.95-54.5; = 0.042). The rate of distal ICA reconstruction below the clinoid segment was 20 (66.7%) in the success group and 1 (14.3%) in the failure group (OR, 12.0; 95% CI, 1.3-113.7; = 0.029). In patients with successful recanalization, no ischemic events occurred after surgery and during follow-up, but restenosis of >50% was found in one case. In the failure group, two patients experienced recurrent ischemic events during follow-up. Perfusion imaging in successful recanalization cases is significantly improved, preoperative I/C ratio was 1.44 (IQR 1.27-1.55), and postoperative 1.12 (IQR 1.05-1.23). National Institutes of Health Stroke Scale (NIHSS) score of successful recanalization cases was 5.35 (2.26) before surgery and 2.03 (1.40) at 6 months ( < 0.01).
Hybrid surgery might be a safe and effective way to treat CAO. Distal internal carotid artery reconstruction to below the clinoid segment and blood reflux after carotid endarterectomy are predictors of successful recanalization.
慢性颈动脉闭塞（CAO）的最佳治疗选择仍不确定。本研究旨在探讨杂交手术治疗 CAO 的安全性和有效性，并确定再通成功的预测因素。
本研究纳入了 2016 年至 2018 年间接受杂交手术治疗的 37 例 CAO 患者。我们提取并分析了患者的人口统计学数据、疾病特征、手术成功率、围手术期并发症和预后。
37 例有症状的 CAO 患者接受了杂交手术治疗。30 例（81.1%）成功再通，7 例未再通。成功组 18 例（60%）和失败组 1 例（14.3%）患者颈动脉内膜切除术（CEA）后出现血液反流（OR，9.0；95%CI，0.95-54.5； = 0.042）。成功组远端颈内动脉（ICA）重建至蝶骨段以下的比例为 20 例（66.7%），失败组为 1 例（14.3%）（OR，12.0；95%CI，1.3-113.7； = 0.029）。在成功再通的患者中，手术后和随访期间均未发生缺血事件，但 1 例发现再狭窄>50%。在失败组中，2 例患者在随访期间出现复发性缺血事件。成功再通患者的灌注成像明显改善，术前 I/C 比值为 1.44（IQR 1.27-1.55），术后为 1.12（IQR 1.05-1.23）。成功再通病例的国立卫生研究院卒中量表（NIHSS）评分术前为 5.35（2.26），术后 6 个月为 2.03（1.40）（ < 0.01）。
杂交手术可能是治疗 CAO 的一种安全有效的方法。颈内动脉远端重建至蝶骨段以下和 CEA 后血液反流是再通成功的预测因素。
