Kniemeyer H W, Aulich A, Schlachetzki F, Steinmetz H, Sandmann W
Clinic of Vascular Surgery and Kidney Transplantation, Heinrich-Heine University, Duesseldorf, Germany.
Eur J Vasc Endovasc Surg. 1996 Oct;12(3):310-20. doi: 10.1016/s1078-5884(96)80250-4.
Occluded internal carotid arteries imply a high risk of ischaemic complications, but an "occluded" carotid artery is not always totally occluded. Pseudo- and segmental occlusions can be detected angiographically, and increasingly non-invasively, and include a variety of morphologic findings.
128 patients with pseudo- or segmental occlusion were treated in a 13 year period. Three different types of pseudo- or segmental occlusion were identified. In most cases a subtotal stenosis (near-occlusion) at the carotid bifurcation is the underlying lesion (type I). In approximately 35% the internal carotid artery is totally occluded at the bifurcation, but collaterals prevent downstream occlusion (type II), or retrograde flow from the circle of Willis and ophthalmic artery preserves a patent petrous part and siphon (type III).
In 79% patency of the arteries could be restored. Three patients (2.3%) died perioperatively, nine (7%) developed ischaemic stroke (7 ipsilateral, 2 contralateral), one intracerebral haemorrhage. The combined stroke-mortality rate was 8.6%. During follow-up (41 +/- 29.9 months) four patients (4.5%) experienced a stroke (3 ipsilateral, 1 contralateral), one an intracranial (1.1%) haemorrhage and six transient ischaemic attacks (6.7%). The annual ipsilateral stroke rate was 0.9%, the cumulative patency rate of the entire series 78% after 73 months.
Although the surgical management carries an increased risk of complications (stroke, transient ischaemic attacks) compared to conventional carotid endarterectomy it is likely that the stroke risk can be reduced at least for symptomatic patients. Symptomatic internal carotid artery occlusion diagnosed non-invasively should be confirmed angiographically to exclude pseudo- or segmental occlusion.
颈内动脉闭塞意味着缺血性并发症的高风险，但“闭塞”的颈动脉并不总是完全闭塞。假性和节段性闭塞可通过血管造影检测到，并且越来越多地通过非侵入性检测到，包括各种形态学表现。
在13年期间对128例假性或节段性闭塞患者进行了治疗。确定了三种不同类型的假性或节段性闭塞。在大多数情况下，颈动脉分叉处的次全狭窄（接近闭塞）是潜在病变（I型）。在大约35%的病例中，颈内动脉在分叉处完全闭塞，但侧支循环可防止下游闭塞（II型），或者来自 Willis 环和眼动脉的逆行血流可使岩部和虹吸部保持通畅（III型）。
79%的动脉可以恢复通畅。3例患者（2.3%）围手术期死亡，9例（7%）发生缺血性卒中（7例同侧，2例对侧），1例发生脑出血。卒中死亡率合并为8.6%。在随访期间（41±29.9个月），4例患者（4.5%）发生卒中（3例同侧，1例对侧），1例发生颅内出血（1.1%），6例发生短暂性脑缺血发作（6.7%）。同侧年卒中发生率为0.9%，整个系列在73个月后的累积通畅率为78%。
尽管与传统的颈动脉内膜切除术相比，手术治疗并发症（卒中、短暂性脑缺血发作）的风险增加，但对于有症状的患者，卒中风险可能至少可以降低。通过非侵入性诊断的有症状颈内动脉闭塞应通过血管造影确认，以排除假性或节段性闭塞。
