Stroke Center, Cerebrovascular Disease Hospital, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan Province, China.
Sci Rep. 2024 May 13;14(1):10945. doi: 10.1038/s41598-024-61938-y.
To investigate the significance of atherosclerotic plaque location in hybrid surgery comprising both endovascular recanalization approaches and carotid endarterectomy for symptomatic atherosclerotic non-acute long-segment occlusion of the internal carotid artery (ICA), 162 patients were enrolled, including 120 (74.1%) patients in the proximal plaque group and 42 (25.9%) in the distal plaque group. Surgical recanalization was performed in all patients, with successful recanalization in 119 (99.2%) patients in the proximal and 39 (92.9%) in the distal plaque group. The total successful recanalization rate was 97.5% (158/162) with a failure rate of 2.5% (4/162). Periprocedural complications occurred in 5 (4.2% or 5/120) patients in the proximal plaque group, including neck infection in two (1.7%), recurrent nerve injury in 1 (0.8%), and laryngeal edema in 2 (1.7%), and 2 (4.8%) in the distal plaque group, including femoral puncture infection in 2 (4.8%). No severe complications occurred in either group. Univariate analysis showed plaque location was a significant (P = 0.018) risk factor for successful recanalization, and multivariate analysis indicated that the plaque location remained a significant independent risk factor for recanalization success (P = 0.017). In follow-up 6-48 months after the recanalization surgery, reocclusion occurred in two (2.8%) patients in the proximal plaque group and 4 (13.3%) in the distal plaque group. In conclusion, although hybrid surgery achieves similar outcomes in patients with ICA occlusion caused by either proximal or distal atherosclerotic plaques, plaque location may be a significant risk factor for successful recanalization of symptomatic non-acute long-segment ICA occlusion.
为了探讨血管内再通治疗联合颈动脉内膜切除术的杂交手术中动脉粥样硬化斑块位置对有症状的非急性长节段颈内动脉（ICA）闭塞的意义，共纳入 162 例患者，其中近端斑块组 120 例（74.1%），远端斑块组 42 例（25.9%）。所有患者均进行了手术再通，近端斑块组 119 例（99.2%）和远端斑块组 39 例（92.9%）再通成功。总的再通成功率为 97.5%（158/162），失败率为 2.5%（4/162）。近端斑块组有 5 例（4.2%或 5/120）患者发生围手术期并发症，包括 2 例（1.7%）颈部感染、1 例（0.8%）迷走神经损伤和 2 例（1.7%）喉水肿，远端斑块组有 2 例（4.8%）患者发生并发症，包括 2 例（4.8%）股动脉穿刺感染。两组均无严重并发症发生。单因素分析显示，斑块位置是再通成功的显著危险因素（P=0.018），多因素分析表明，斑块位置仍是再通成功的显著独立危险因素（P=0.017）。在再通手术后 6-48 个月的随访中，近端斑块组有 2 例（2.8%）患者和远端斑块组有 4 例（13.3%）患者再闭塞。总之，尽管杂交手术在由近端或远端动脉粥样硬化斑块引起的 ICA 闭塞患者中取得了相似的结果，但斑块位置可能是有症状的非急性长节段 ICA 闭塞再通的一个显著危险因素。
