Department of Vascular Surgery, 37795University of Patras Medical School, Greece.
Department of Anatomy, School of Medicine, 69183National and Kapodistrian University of Athens, Greece.
Vasc Endovascular Surg. 2021 May;55(4):342-347. doi: 10.1177/1538574420985767. Epub 2021 Jan 18.
To describe the frequency, factors associated with, and significance of surgical dissection maneuvers of the distal internal carotid artery (ICA) during carotid endarterectomy (CEA).
In this retrospective analysis of prospectively collected information in patients undergoing CEA, we recorded information on demographics, risk factors and comorbidities, dissection maneuvers of the distal ICA, other operative variables and neurological outcome measures.
During the period July 2008 and February 2020 inclusive, 218 consecutive patients (180 males, median age 69.5 years) underwent 240 CEAs. In 117 (48.8%) of them, CEA was performed for a symptomatic stenosis. Dissection maneuvers of the distal ICA were required in 77 cases (32.1%), including division and ligation of the sternocleidomastoid vessels in 66 cases (27.5%), mobilization of the XII cranial nerve in 69 cases (28.7%, with concomitant transection of the superior root of the ansa cervicalis in 11 cases, 4.6%) and division of the posterior belly of the digastric muscle in 8 cases (3.3%). Styloid osteotomy was not required in any case. Smoking was the single predictive factor associated with the use of an adjunctive dissection maneuver (odds ratio 2.23, p = 0.009). The use of a patch was more common in smokers (16% vs 7.1% in non-smokers, odds ratio 2.48, p = 0.05). Perioperative stroke and/or death rate was 0%, not allowing testing for associations with maneuver performance. Two patients (0.8%) developed a transient ischemic attack and 4 patients (1.7%) a cranial nerve injury (CNI), including 2 patients with recurrent laryngeal nerve palsy, diagnosed on routine laryngoscopy during planning of a contralateral CEA. There was no association between CNI and dissection of the distal ICA using an operative adjunct (p = 0.60).
Several surgical maneuvers are often required to accomplish dissection of the distal ICA beyond the point of atherosclerotic disease. When dictated by operative findings, such maneuvers are deemed safe.
描述颈动脉内膜切除术（CEA）过程中远端颈内动脉（ICA）的解剖操作的频率、与操作相关的因素以及其重要性。
在对接受 CEA 的患者前瞻性收集信息的回顾性分析中，我们记录了人口统计学、风险因素和合并症、远端 ICA 的解剖操作、其他手术变量和神经功能结果测量的信息。
在 2008 年 7 月至 2020 年 2 月期间，连续 218 例患者（180 例男性，中位年龄 69.5 岁）接受了 240 例 CEA。其中 117 例（48.8%）因症状性狭窄而行 CEA。77 例（32.1%）需要进行远端 ICA 的解剖操作，包括 66 例（27.5%）切断并结扎胸锁乳突肌血管、69 例（28.7%）牵开第 XII 颅神经，其中 11 例（4.6%）同时切断颈袢上根、8 例（3.3%）切断二腹肌后腹。在任何情况下都不需要进行茎突截骨术。吸烟是唯一与辅助解剖操作相关的预测因素（比值比 2.23，p = 0.009）。吸烟者更常使用补片（16%比非吸烟者 7.1%，比值比 2.48，p = 0.05）。围手术期卒中或死亡率为 0%，无法检验与操作性能的关联。2 例患者（0.8%）发生短暂性脑缺血发作，4 例患者（1.7%）发生颅神经损伤（CNI），包括 2 例因常规喉镜检查诊断为喉返神经麻痹的患者，在计划对侧 CEA 时。当操作发现需要时，使用手术辅助进行远端 ICA 解剖与 CNI 之间没有关联（p = 0.60）。
为了完成动脉粥样硬化病变远端 ICA 的解剖，通常需要进行几种手术操作。在手术发现需要时，这些操作被认为是安全的。
