Department of Vascular and Endovascular Surgery, Shanghai Changzheng Hospital affiliated to Naval Medical University, Shanghai, District of Huangpu, Fengyang Road 415, Shanghai 200003, China.
Department of Vascular and Endovascular Surgery, Shanghai Changzheng Hospital affiliated to Naval Medical University, Shanghai, District of Huangpu, Fengyang Road 415, Shanghai 200003, China.
J Stroke Cerebrovasc Dis. 2021 Apr;30(4):105611. doi: 10.1016/j.jstrokecerebrovasdis.2021.105611. Epub 2021 Jan 15.
Hybrid and endovascular procedures maybe effective and less invasive alternatives to open surgery for treatment of extracranial carotid artery aneurysm (ECAA), but the optimal management of juxta-skullbase ECAA is controversial.
This study evaluated the long-term effects of hybrid and endovascular procedures in treating juxta-skullbase ECAA.
The records of 9 consecutive patients who underwent hybrid or endovascular interventions for juxta-skullbase ECAA in a single center from April 2014 to May 2020 were retrospectively reviewed.
Four patients presented with a pulsating mass, 1 with dysphagia, 1 with pain in the left temporal region, 1 with dizziness and headache, 1 with cerebral infarction, and 1 with dizziness and cerebral infarction. Seven true aneurysms, 1 false aneurysm, and 1 dissecting aneurysm were diagnosed with CTA in the 9 patients (mean age, 50.8±20.3 years; 1 male). The aneurysms were divided into two subgroups: 4 type I, and 5 type IIb according to a recent classification. Per schedule, 7 patients (4 type I and 3 type IIb) were treated with endovascular intervention, and 2 (type IIb) were treated with hybrid procedures. The technique success rate was 88.9%. One patient (type IIb) who was scheduled to be treated with an endovascular procedure was transferred to a hybrid procedure because of failure of the endovascular procedure. Eleven covered stents were implanted to exclude the aneurysms. During follow-up (mean duration 31.2±23.2 months), all aneurysms were proven excluded, no significant complication occurred, and preoperative symptoms resolved. One patient (type I) in the endovascular group had occlusion of the internal carotid artery but no symptoms; the internal carotid artery was patent in the other 8 patients.
Hybrid and endovascular procedures were found effective and durable alternatives to open operation for treatment of extracranial juxta-skullbase carotid aneurysm.
对于治疗颅外颈动脉瘤（ECAA），杂交和血管内手术可能是开放手术的有效且微创的替代方法，但颅底旁 ECAA 的最佳治疗方法仍存在争议。
本研究评估了杂交和血管内手术治疗颅底旁 ECAA 的长期效果。
回顾性分析 2014 年 4 月至 2020 年 5 月在单中心接受杂交或血管内介入治疗颅底旁 ECAA 的 9 例连续患者的记录。
4 例患者表现为搏动性肿块，1 例吞咽困难，1 例左侧颞区疼痛，1 例头晕头痛，1 例脑梗死，1 例头晕脑梗死。9 例患者 CTA 诊断为 7 个真性动脉瘤、1 个假性动脉瘤和 1 个夹层动脉瘤（平均年龄 50.8±20.3 岁，1 例男性）。根据最近的分类，动脉瘤分为两组：4 型 I 型和 5 型 IIb 型。根据计划，7 例（4 型 I 型和 3 型 IIb 型）患者接受血管内介入治疗，2 例（IIb 型）患者接受杂交治疗。技术成功率为 88.9%。1 例（IIb 型）患者因血管内手术失败而转为杂交手术。11 枚覆膜支架植入排除动脉瘤。随访期间（平均随访时间 31.2±23.2 个月），所有动脉瘤均被证实排除，无明显并发症发生，术前症状缓解。血管内组 1 例（I 型）患者颈内动脉闭塞，但无症状；其余 8 例患者颈内动脉通畅。
杂交和血管内手术是治疗颅外颅底旁颈动脉瘤的有效且持久的替代开放手术的方法。
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