Porto Carl M, Sastry Rahul A, Torabi Radmehr, Santos Fontanez Santos E, Feler Joshua, Ranellone Tyler, Moldovan Krisztina, Shaaya Elias, Jayaraman Mahesh V, Doberstein Curtis, Wolman Dylan N
The Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
J Neuroendovasc Ther. 2025;19(1). doi: 10.5797/jnet.oa.2025-0050. Epub 2025 Jun 24.
Carotid endarterectomy (CEA) is a standard treatment for atherosclerotic carotid stenosis. Perioperative symptomatic restenosis or reocclusion of the carotid artery following CEA is a rare but serious complication that typically necessitates intervention. The efficacy and safety profile of emergent endovascular therapy (EVT) as an alternative to repeat CEA in the treatment of acute perioperative neurological decline remain unknown.
All patients undergoing CEA in the Department of Neurosurgery at a single comprehensive stroke center from 2015 to 2024 were reviewed. Patients who underwent EVT for acute perioperative neurological deficits were included in our series. A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify articles relevant to the endovascular management of acute neurological deficits following CEA.
Four patients from our institutional cohort met the inclusion criteria. An additional 39 patients were identified from the literature review in 11 source articles, which yielded a total of 43 patients. CEA was performed for symptomatic lesions in 28 (28/32, 87.5%) patients. Abnormal angiographic findings were reported for all patients. Thrombus accumulation in or distal to the operated internal carotid artery (ICA) (26/43, 60.5%) and dissection flaps (15/43, 34.9%) were the most common findings. Five (11.6%) patients had tandem cervical ICA and intracranial occlusions, of which thrombectomy of the intracranial lesion was successfully performed on 3 patients. All patients except for 1 (42/43, 97.6%) underwent technically successful endovascular stenting. Following EVT, 76.7% (33/43) of patients had no persisting neurological deficits. Nine (20.9%) patients were found to have new cerebral infarcts on post-EVT imaging. In-hospital mortality was reported for 6 patients (14%), 4 of whom were found to have tandem cervical ICA and intracranial occlusions.
EVT is likely a technically viable alternative treatment for patients with perioperative acute neurologic deficits after CEA. However, most of the literature available comes from case series, thereby limiting the quality of evidence. Improved reporting of standard stroke outcome measures may help to inform the implementation of EVT and repeat CEA for acute ischemic symptoms after CEA.
颈动脉内膜切除术（CEA）是治疗动脉粥样硬化性颈动脉狭窄的标准方法。CEA术后围手术期出现有症状的颈动脉再狭窄或再闭塞是一种罕见但严重的并发症，通常需要进行干预。作为重复CEA的替代方法，急诊血管内治疗（EVT）在治疗围手术期急性神经功能减退方面的疗效和安全性尚不清楚。
回顾了2015年至2024年在一家综合性卒中中心神经外科接受CEA的所有患者。本系列纳入了因围手术期急性神经功能缺损接受EVT的患者。根据系统评价和Meta分析的首选报告项目（PRISMA）指南进行系统文献回顾，以确定与CEA后急性神经功能缺损的血管内治疗相关的文章。
我们机构队列中的4例患者符合纳入标准。通过对11篇来源文章的文献回顾又确定了39例患者，共计43例患者。28例（28/32，87.5%）患者因有症状的病变接受了CEA。所有患者均报告有血管造影异常表现。手术侧颈内动脉（ICA）内或其远端的血栓形成（26/43，60.5%）和夹层瓣（15/43，34.9%）是最常见的表现。5例（11.6%）患者存在串联性颈段ICA和颅内闭塞，其中3例成功进行了颅内病变的取栓术。除1例患者外（42/43，97.6%），所有患者的血管内支架置入术在技术上均获成功。EVT术后，76.7%（33/43）的患者无持续神经功能缺损。9例（20.9%）患者在EVT后影像学检查中发现有新发性脑梗死。报告有6例患者（14%）院内死亡其中4例存在串联性颈段ICA和颅内闭塞。
对于CEA术后围手术期急性神经功能缺损的患者，EVT可能是一种技术上可行的替代治疗方法。然而，现有大多数文献来自病例系列，因此证据质量有限。改进标准卒中结局指标的报告可能有助于为CEA后急性缺血症状的EVT和重复CEA的实施提供参考。
