Department of Neurosurgery, Tokyo Women's Medical University.
Department of Neurosurgery, St. Luke's International Hospital.
Neurol Med Chir (Tokyo). 2023 Jun 15;63(6):221-227. doi: 10.2176/jns-nmc.2022-0307. Epub 2023 Mar 31.
Various surgical treatments are available for occlusive subclavian and common carotid artery diseases. Nevertheless, to date, when cerebral endovascular treatment is utilized, revascularization via direct surgery may be required. This study reported five symptomatic cases of revascularization for CCA and SCA occlusive and stenotic lesions that were expected to be challenging to treat with endovascular treatment. We performed subclavian artery-common carotid artery or internal carotid artery bypass using artificial blood vessels or saphenous vein grafts in five patients with subclavian steal syndrome, symptomatic common carotid artery occlusion, and severe proximal common carotid artery stenosis. In this study, good bypass patency was achieved in all five cases. Although there were no intraoperative complications, one patient had a postoperative lymphatic leak. Moreover, there was no recurrence of stroke during postoperative follow-up for an average of 2 years. Conclusively, subclavian artery-common carotid artery bypass can be an effective surgical treatment for common carotid artery occlusion, proximal common carotid artery stenosis, and subclavian artery occlusion.
各种手术治疗方法可用于治疗闭塞性锁骨下动脉和颈总动脉疾病。然而,迄今为止,当进行脑血管内治疗时,可能需要通过直接手术进行血运重建。本研究报告了 5 例 CCA 和 SCA 闭塞和狭窄病变的血管重建病例,这些病例预计用血管内治疗难以治疗。我们对 5 例患有锁骨下窃血综合征、症状性颈总动脉闭塞和严重颈总动脉近端狭窄的患者进行了锁骨下动脉-颈总动脉或颈内动脉旁路移植术,使用人工血管或大隐静脉移植物。在本研究中,5 例患者的旁路均保持良好通畅。虽然没有术中并发症,但有 1 例患者术后出现淋巴漏。此外,在平均 2 年的术后随访期间,没有再次发生中风。总之,锁骨下动脉-颈总动脉旁路术可以成为治疗颈总动脉闭塞、颈总动脉近端狭窄和锁骨下动脉闭塞的有效手术治疗方法。