Coyle K A, Smith R B, Salam A A, Dodson T F, Chaikof E L, Lumsden A B
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Cardiovasc Surg. 1996 Feb;4(1):71-5. doi: 10.1016/0967-2109(96)83788-4.
A total of 116 carotid endarterectomies were performed in patients with a totally occluded opposite internal carotid artery over a 10-year period from 1983 until 1992. The average age of patients was 66.4 years; 75% were men and 25% were women. The average degree of stenosis on the operated side was 76.7%. Twenty-one patients (18.1%) had had a documented previous stroke referrable to the side of the occlusion; 22 had a neurologic deficit attributable to the occluded vessel at the time of preoperative evaluation. Indications for surgery included transient ischemic attacks in 35 (30.2%), ipsilateral stroke in 10 (8.6%), amaurosis fugax in 11 (9.5%), and high-grade asymptomatic stenosis in 60 (51.7%). Forty-eight percent of the procedures were performed using local anesthesia, with intraluminal shunts inserted in all except one patient. The combined 30-day mortality and stroke morbidity in this population was 4.3%, which is comparable with a combined stroke and death rate of 4.0% among 956 patients without contralateral carotid occlusion undergoing endarterectomy during this period. This experience suggests that endarterectomy can be performed safely in the patient with internal carotid occlusion and is an important mechanism for the prevention of stroke.
在1983年至1992年的10年期间，对116例对侧颈内动脉完全闭塞的患者进行了颈动脉内膜切除术。患者的平均年龄为66.4岁；75%为男性，25%为女性。手术侧的平均狭窄程度为76.7%。21例患者（18.1%）既往有明确的与闭塞侧相关的中风病史；22例在术前评估时有与闭塞血管相关的神经功能缺损。手术指征包括35例（30.2%）短暂性脑缺血发作、10例（8.6%）同侧中风、11例（9.5%）一过性黑矇和60例（51.7%）高度无症状性狭窄。48%的手术采用局部麻醉，除1例患者外均插入腔内分流管。该人群30天的死亡率和中风发病率合并为4.3%，与同期956例无对侧颈动脉闭塞接受内膜切除术患者的中风和死亡率合并率4.0%相当。这一经验表明，颈动脉内膜切除术可在颈内动脉闭塞患者中安全进行，是预防中风的重要手段。
