Van Damme H, Gillain D, Désiron Q, Detry O, Albert A, Limet R
Department of Cardiovascular Surgery, University Hospital of Liège, Belgium.
Acta Chir Belg. 1996 Feb;96(1):15-22.
The authors report on 62 surgical corrections for kinking of the internal carotid artery during a 13-year period (1980-1993). This represents 2.8% of all carotid operative procedures (n = 2188) in the same period. It always concerned a significant (< 60 degrees) angulation of a redundant internal carotid artery, that in all but 3 cases was associated with atherosclerotic involvement of the carotid bifurcation. The indication to surgery included transient hemispheric or ocular ischaemia in 25.5% of cases, a regressive neurologic deficit in 8%, a minor stroke in 3%, a stroke in evolution in 11%, and non-lateralized cerebral ischaemia in 21%. In 19 patients (31%) it concerned an asymptomatic high degree stenosis. The surgical technique consisted in carotid transposition-reimplantation after eversion endarterectomy in 37 cases, in posterior transverse plication with patch angioplasty in 20 cases, and in segmental excision with venous interposition graft in 5 cases. There was one postoperative death. The morbidity include one ipsilateral non-fatal stroke and 3 transient ischaemic attacks. A complete long-term follow-up (mean duration 3.4 years) is available for 57 patients. The late incidence of stroke is 1.5% per year. The 5-year survival attains 67%. These long-term results are comparable to the outcome of standard endarterectomy in the same institution. The authors discuss the indication, techniques, and outcome of surgical correction of kinked internal carotid artery. They recommend a shortening procedure, often associated with endarterectomy for severely kinked vessels (angulation 60 degrees or less), symptomatic or not.
作者报告了13年期间（1980 - 1993年）62例因颈内动脉扭结而行的外科矫正手术。这占同期所有颈动脉手术（n = 2188例）的2.8%。该病症总是涉及到颈内动脉冗长且显著（< 60度）的成角，除3例以外，所有病例均伴有颈动脉分叉处的动脉粥样硬化累及。手术指征包括25.5%的病例出现短暂性半球或眼部缺血、8%的病例出现进行性神经功能缺损、3%的病例出现轻度中风、11%的病例出现进展性中风以及21%的病例出现非定位性脑缺血。19例患者（31%）存在无症状的高度狭窄。手术技术包括37例外翻内膜切除术后行颈动脉转位再植术、20例后路横向折叠加补片血管成形术以及5例节段性切除并植入静脉移植血管术。术后有1例死亡。并发症包括1例同侧非致命性中风和3次短暂性脑缺血发作。57例患者有完整的长期随访（平均时长3.4年）。中风后期发病率为每年1.5%。5年生存率达67%。这些长期结果与同一机构标准内膜切除术的结果相当。作者讨论了颈内动脉扭结外科矫正的指征、技术和结果。他们推荐一种缩短手术，对于严重扭结的血管（成角60度或更小），无论有无症状，通常都要联合内膜切除术。
