Countee R W, Vijayanathan T, Hubschmann O R, Chavis P
J Neurosurg. 1980 Oct;53(4):491-9. doi: 10.3171/jns.1980.53.4.0491.
Experiences with a patient with symptomatic obstruction to the carotid artery in its petrous segment are described. In spite of the severe stenosis of this vessel, complete arteriography demonstrated excellent perfusion of the symptomatic eye and hemisphere and an ample collateral reserve. Funduscopy confirmed the clinical impression that recurrent retinal and hemispheric ischemia in this patient was the result of microembolism rather than intracranial hemodynamic insufficiency. Consequently, extracranial-intracranial (EC-IC) bypass was believed to offer little benefit to this patient. Abrupt ligation of the internal carotid artery in the neck proved to be an effective method for arresting the embolic discharge from this vessel's inaccessible obstruction, and resulted in prompt and complete relief of ischemic symptoms. It is concluded that identifying the mechanism(s) responsible for recurrent ischemia past uncorrectable carotid obstructions is of paramount importance in order to establish the most appropriate treatment(s). Carotid occlusion is an effective surgical remedy for terminating microembolism from this vessel when it is diseased and incompletely obstructed, and should be considered in selected patients. The importance of angiographic evaluation of naturally occurring EC-IC anastomotic connections in addition to the assessment of intracranial collateral reserves in cases of carotid occlusion is also emphasized.
本文描述了一位患有岩骨段颈动脉症状性梗阻患者的诊疗经历。尽管该血管存在严重狭窄，但完整的血管造影显示有症状的眼睛和半球灌注良好，且有充足的侧支储备。眼底镜检查证实了临床印象，即该患者反复出现的视网膜和半球缺血是微栓塞而非颅内血流动力学不足所致。因此，颅外 - 颅内（EC - IC）旁路手术被认为对该患者益处不大。事实证明，在颈部突然结扎颈内动脉是阻止该血管难以触及的梗阻部位产生栓子脱落的有效方法，并能迅速且完全缓解缺血症状。得出的结论是，为了确定最合适的治疗方法，识别导致无法纠正的颈动脉梗阻后反复缺血的机制至关重要。当颈动脉患病且不完全梗阻时，颈动脉闭塞是终止该血管微栓塞的有效手术补救措施，应在选定的患者中予以考虑。此外，还强调了在颈动脉闭塞病例中，除评估颅内侧支储备外，对自然存在的EC - IC吻合连接进行血管造影评估的重要性。
