Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, People's Republic of China.
Acta Neurochir (Wien). 2022 Dec;164(12):3185-3196. doi: 10.1007/s00701-022-05331-6. Epub 2022 Aug 5.
Common carotid artery occlusion (CCAO) is a rare cause of cerebrovascular events. Symptomatic lesions are resistant to medical treatment and revascularization is often required, but there is no consensus on the treatment of CCAO at present. Riles type 1A CCAO is most likely to benefit from revascularization because it has patent outflow tract (internal carotid artery) which was supplied by patent external carotid artery (ECA) from collateral circulation. We described a novel surgical technique improved on the basis of the carotid endarterectomy (CEA) for treatment of Riles type 1A CCAO.
We rigorously screened ten patients with symptomatic Riles type1A CCAO for surgery from January 2017 to May 2019 and performed a full preoperative assessment of the inadequate collateral circulation compensation. Moreover, we retrospectively reviewed our experience of the segmented CEA in the treatment of them in our single center.
Segmented CEA was performed on the left side in four cases and on the right side in six cases. The technical success rate of the procedure was 100%. Primary suture was used in nine cases. Only one patient (right CCAO) who had a history of neck radiotherapy was treated by the patch CEA. The mean temporary blocking time during surgery was 52.8 ± 9.15 min. The mean temporary blocking time for treating the upper segment of the common carotid artery (CCA) was 11.1 ± 2.64 min. In the postoperative period, cerebral perfusion on the ipsilateral site improved in all patients, myocardial infarction occurred in one patient, and recurrent laryngeal nerve damage occurred in another. No ischemic events or re-occlusion or restenosis (> 50%) of the treated CCA occurred during the mean follow-up of 32.6 ± 9.3 months. The preoperative mean modified Rankin Scale (mRS) score was 1.9 (range, 1-3; median, 2). At last follow-up for all patients, the mRS score was 1 (range, 0-3; median, 1).
Segmented CEA, which utilizes the compensatory effect of collateral circulation, is an effective and safe technique to treat patients suffering from Riles type 1A CCAO with hemodynamic cerebrovascular compromise.
颈总动脉闭塞（CCAO）是一种罕见的脑血管事件病因。有症状的病变对药物治疗有抗性，通常需要血管再通，但目前对于 CCAO 的治疗尚无共识。Riles 1A 型 CCAO 最有可能从再通中获益，因为它有通畅的流出道（颈内动脉），这是由侧支循环中通畅的颈外动脉（ECA）供应的。我们描述了一种基于颈动脉内膜切除术（CEA）的治疗 Riles 1A 型 CCAO 的新型手术技术。
我们从 2017 年 1 月至 2019 年 5 月，严格筛选了 10 例有症状的 Riles 1A 型 CCAO 患者进行手术，并对代偿性循环不足的充分性进行了全面的术前评估。此外，我们回顾性分析了在我们的单中心应用分段 CEA 治疗这些患者的经验。
4 例左侧，6 例右侧行分段 CEA。该手术的技术成功率为 100%。9 例采用一期缝合。仅 1 例（右侧 CCAO）有颈部放疗史的患者行补片 CEA。手术中平均临时阻断时间为 52.8±9.15 分钟。颈总动脉（CCA）上段的平均临时阻断时间为 11.1±2.64 分钟。术后所有患者同侧部位脑灌注均改善，1 例发生心肌梗死，1 例发生喉返神经损伤。在平均 32.6±9.3 个月的随访期间，未发生治疗 CCA 的缺血事件、再闭塞或再狭窄（>50%）。术前平均改良 Rankin 量表（mRS）评分为 1.9（范围 1-3；中位数 2）。所有患者最后一次随访时的 mRS 评分为 1（范围 0-3；中位数 1）。
分段 CEA 利用侧支循环的代偿作用，是一种有效且安全的治疗方法，可治疗因血流动力学性脑血管障碍而出现 Riles 1A 型 CCAO 的患者。
