Sterpetti A V, Schultz R D, Feldhaus R J
Department of Surgery, Creighton University School of Medicine, Omaha, NE 68131.
J Vasc Surg. 1988 Jan;7(1):31-9. doi: 10.1067/mva.1988.avs0070031.
In the past 14 years, 22 patients (25 operated sides), with occlusion of the internal carotid artery (ICA), underwent ipsilateral external carotid artery (ECA) endarterectomy at our institution. Operative indications were amaurosis fugax in 13 sides and nonlateralizing transient ischemic attacks in the remaining 12. There were no operative deaths. One patient suffered a minor stroke after operation. Follow-up ranged from 6 to 110 months (median 36 months). In 16 cases, simple endarterectomy with or without vein patch closure was performed (type I). In two cases the ostium of the ICA was occluded with interrupted sutures after endarterectomy (type II). In the remaining seven cases the ICA was transposed as a patch over the endarterectomized ECA after endarterectomy (type III). All but six patients (six sides) underwent duplex scanning or angiography during follow-up. Four of nine patients with previous nonlateralizing symptoms had persistent symptoms after operation, whereas none of those with previous amaurosis fugax did. Recurrent occlusive disease was more common in type I reconstructions (p less than 0.05). Proper ECA reconstruction results in long-term patency. In the patient with ipsilateral ICA occlusion, transposition of the ICA as a patch over the endarterectomized ECA offers a valid hemodynamic solution. Objective parameters are needed to identify patients with nonlateralizing symptoms who will benefit from operation.
在过去14年中,我院对22例(25侧手术)颈内动脉(ICA)闭塞患者进行了同侧颈外动脉(ECA)内膜切除术。手术指征为13侧的一过性黑矇和其余12侧的无定位性短暂性脑缺血发作。无手术死亡病例。1例患者术后发生轻度卒中。随访时间为6至110个月(中位时间36个月)。16例患者进行了单纯内膜切除术,伴或不伴静脉补片修补(I型)。2例患者在内膜切除术后用间断缝线封闭ICA开口(II型)。其余7例患者在内膜切除术后将ICA转位作为补片覆盖在切除内膜的ECA上(III型)。除6例患者(6侧)外,所有患者在随访期间均接受了双功扫描或血管造影。9例既往有非定位性症状的患者中有4例术后仍有持续症状,而既往有一过性黑矇的患者术后均无此类症状。I型重建中复发性闭塞性疾病更为常见(p<0.05)。恰当的ECA重建可实现长期通畅。对于同侧ICA闭塞患者,将ICA转位作为补片覆盖在切除内膜的ECA上可提供有效的血流动力学解决方案。需要客观参数来识别能从手术中获益的有非定位性症状的患者。