Gonzalez-Urquijo Mauricio, Vargas Jose Francisco, Marchesini Michelle, Marine Leopoldo, Mertens Renato, Valdes Francisco, Godoy-Santín Jaime, Mellado Patricio, Miranda Hector, Zoroquiaín José Pablo, Sandoval Patricio
Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Ann Vasc Surg. 2025 Jan;110(Pt A):114-122. doi: 10.1016/j.avsg.2024.07.107. Epub 2024 Sep 27.
The present study aims to describe the clinical characteristics and treatment outcomes of patients with symptomatic carotid web treated at a single institution in South America.
Retrospective study of a single-center experience of patients with carotid webs surgically treated from September 2019 to September 2023.
Ten patients had carotid webs, 6 (60%) were females. Median age was 54.5 years (range: 35-77 years). All patients were symptomatic. Diagnosis was made in 90% (n = 9) of the patients with either computed tomography angiography or magnetic resonance alone. One (10%) patient underwent angiography for definite diagnosis. The median interval from the first neurological event to intervention was 90 months (range: 3 days-108 months). Four (40%) patients underwent surgical treatment within 1 month from symptom onset and carotid web diagnosis, with a median of 3.5 days (range: 3-9 days). Six (60%) patients underwent delayed surgical treatment since the cause of the neurological event was uncertain, with a median of 54 months (range: 6-108 months). These 6 patients had recurrent neurological events. Three (30%) patients underwent carotid endarterectomies with polyurethane patch and 3 (30%) by eversion technique. Three (30%) patients underwent segmental resection and reanastomosis of the internal carotid artery. One underwent internal carotid artery plasty with saphenous vein. At a median follow-up of 30 months (range: 6-46 months), 1 patient persists with mild aphasia, another patient has severe aphasia and right hemiparesis, both as sequelae of their initial strokes, and another patient has suffered 3 nonischemic episodes of brief transient right hemiparesis attributed to epileptic seizures. The other 7 patients remain without new neurological events.
Neurological events of carotid distribution deserve accurate imaging work up, keeping in mind the diagnosis of carotid web. Surgical treatment for carotid web seems effective for preventing recurrences; nevertheless, further studies are warranted to define the best management for these patients.
本研究旨在描述在南美洲一家机构接受治疗的有症状颈动脉网患者的临床特征和治疗结果。
对2019年9月至2023年9月接受手术治疗的颈动脉网患者的单中心经验进行回顾性研究。
10例患者患有颈动脉网，6例（60%）为女性。中位年龄为54.5岁（范围：35 - 77岁）。所有患者均有症状。90%（n = 9）的患者通过计算机断层血管造影或单独的磁共振成像确诊。1例（10%）患者接受血管造影以明确诊断。从首次神经事件到干预的中位间隔时间为90个月（范围：3天 - 108个月）。4例（40%）患者在症状发作和颈动脉网诊断后的1个月内接受了手术治疗，中位时间为3.5天（范围：3 - 9天）。6例（60%）患者因神经事件的原因不确定而接受了延迟手术治疗，中位时间为54个月（范围：6 - 108个月）。这6例患者有复发性神经事件。3例（30%）患者接受了带聚氨酯补片的颈动脉内膜切除术，3例（30%）采用外翻技术。3例（30%）患者接受了颈内动脉节段切除和再吻合术。1例患者接受了大隐静脉颈内动脉成形术。中位随访30个月（范围：6 - 46个月）时，1例患者仍有轻度失语，另1例患者有严重失语和右侧偏瘫，均为初始卒中的后遗症，还有1例患者因癫痫发作出现3次短暂性右侧偏瘫的非缺血性发作。其他7例患者未出现新的神经事件。
颈动脉分布区的神经事件值得进行准确的影像学检查，同时要考虑到颈动脉网的诊断。颈动脉网的手术治疗似乎对预防复发有效；然而，需要进一步研究来确定这些患者的最佳治疗方案。
