Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China,
Department of Cerebrovascular Diseases, Suining Central Hospital, Suining, China,
Cerebrovasc Dis. 2024;53(2):205-215. doi: 10.1159/000535373. Epub 2023 Dec 7.
Chronic internal carotid artery occlusion (CICAO) is a common cause of stroke and ischemia recurrence. An increasing number of reports have highlighted the potential of hybrid surgery for treating CICAO. There are few studies, specifically nonrandomized controlled trials, on the safety and effectiveness of hybrid surgery for the treatment of CICAO, so in this study, we hypothesized that hybrid surgery would be safe, have an acceptable complication rate and a high success rate.
MEDLINE, Embase, Cochrane Library, and Web of Science databases were searched for relevant studies published up to January 30, 2023. The primary endpoint was recanalization rates of occluded vessels, and the secondary endpoint was perioperative death and procedure-related complications. Subgroup analysis focused on the recanalization rates of endovascular intervention (EI) and hybrid surgery, as well as the rates of recanalization below the clinoid segment and at the clinoid segment and beyond. The follow-up visit was conducted at least 3 months after surgery, and stenosis or occlusion recurrence was confirmed by review of CTA or DSA scan.
The databases were searched and 1,709 records were identified, of which 16 articles were used in the meta-analysis, and 464 CICAO patients with complete data who underwent hybrid surgery were enrolled. Hybrid surgery was associated with higher success rates (RD = 0.87, 95% CI [0.84-0.91], p < 0.00001) than EI (OR = 4.71, 95% CI [2.32-9.56], p < 0.0001). The procedural success rate in the below-clinoid segment group was significantly higher than that in the clinoid segment and beyond group (OR = 13.76, 95% CI [5.31-35.66], p < 0.00001). The total periprocedural complication rate was low (RD = 0.11, 95% CI [0.07-0.15], p < 0.00001 and RD = 0.04, 95% CI [0.00-0.07], p = 0.03). Target vessel restenosis or reocclusion occurred in 35 patients (8%) during the follow-up period (RD = 0.08, 95% CI [0.04-0.12], p < 0.0001).
Hybrid surgery is the combination of the advantages of open surgery and EI, has a high success rate and a low risk of recurrence of stenosis and occlusion in the long term. Randomized controlled trials on hybrid surgery for internal carotid artery occlusion are necessary.
慢性颈内动脉闭塞（CICAO）是中风和缺血性复发的常见原因。越来越多的报告强调了杂交手术治疗 CICAO 的潜力。关于杂交手术治疗 CICAO 的安全性和有效性的研究很少，特别是没有随机对照试验，因此在这项研究中，我们假设杂交手术是安全的，并发症发生率可接受，成功率高。
检索 MEDLINE、Embase、Cochrane 图书馆和 Web of Science 数据库，以获取截至 2023 年 1 月 30 日发表的相关研究。主要终点是闭塞血管的再通率，次要终点是围手术期死亡和与手术相关的并发症。亚组分析侧重于血管内介入（EI）和杂交手术的再通率，以及颅前段以下和颅前段及以上的再通率。术后至少 3 个月进行随访，通过 CTA 或 DSA 扫描复查确认狭窄或闭塞复发。
对数据库进行了检索，共确定了 1709 条记录，其中 16 篇文章用于荟萃分析，共纳入了 464 例接受杂交手术的 CICAO 患者，数据完整。与 EI 相比，杂交手术的成功率更高（RD = 0.87，95%CI [0.84-0.91]，p < 0.00001）（OR = 4.71，95%CI [2.32-9.56]，p < 0.0001）。颅前段以下组的手术成功率明显高于颅前段和颅后段组（OR = 13.76，95%CI [5.31-35.66]，p < 0.00001）。围手术期总并发症发生率较低（RD = 0.11，95%CI [0.07-0.15]，p < 0.00001 和 RD = 0.04，95%CI [0.00-0.07]，p = 0.03）。在随访期间，有 35 例（8%）患者发生靶血管再狭窄或再闭塞（RD = 0.08，95%CI [0.04-0.12]，p < 0.0001）。
杂交手术结合了开放手术和 EI 的优势，具有较高的成功率，长期狭窄和闭塞的复发风险较低。有必要进行关于杂交手术治疗颈内动脉闭塞的随机对照试验。
