Sato M, Nishizaka T, Endo Y, Maeno K, Takahagi S
Department of Neurosurgery, Hoshi General Hospital, Fukushima, Japan.
No Shinkei Geka. 1996 Oct;24(10):885-90.
In a couple of recent randomized trials, the benefits of unilateral carotid endarterectomy (CEA) have been reevaluated in symptomatic patients with severe stenosis. In contrast, the operative indication, procedure, and perioperative management of bilateral CEAs for patients with bilateral carotid artery stenosis are still controversial. In this report, we reviewed 7 patients who underwent bilateral CEAs at out institute during the last 10 years, with regard to the clinical feature, angiographical findings, operative procedure, surgical results and long-term prognosis. The patients ranged from 52 to 73 years in age, and included six males and one female. Clinical symptoms were asymptomatic in 1 patient, transient ischemic attack in 2, reversible ischemic neurological deficits in 2, minor completed stroke in 1, and major completed stroke in 1. The angiographical carotid artery stenosis in the dominant side of symptomatic cases was 50% in 3, 70% in 1, 90% in 2, and ulceration in 4 cases. The stenosis in the non-dominant side of symptomatic cases was 60% in 1, 70% in 3, 90% in 2, and 4 cases with ulceration. One case among the asymptomatic cases had bilateral 80-90% stenosis. We staged bilateral CEAs, in the dominant side first except in one case among the symptomatic cases and on the more severely stenotic side first in the asymptomatic cases. During CEA, an external shunt was placed in 1 case, but no internal shunt was used in any of the cases. Perioperative complications were found in 2 patients, transient bilateral hypoglossal nerve palsy and local hemorrhage in the other case. Totally, all of 7 cases (14 consecutive CEAs) have been performed with satisfactory results. No mortality and no permanent morbidity has resulted. In the follow-up period (mean: 38.3 month), 1 patient was found to have developed cerebral infarction in the ipsilateral carotid artery territory. From our own small experience and from that in the literature, CEAs for bilateral carotid artery stenosis should be performed in the dominant side first. Then, after a certain period, from 2 to 6 weeks, the CEA should be performed in the non-dominant side.
在最近的几项随机试验中，对有症状的严重狭窄患者进行了单侧颈动脉内膜切除术（CEA）的益处重新评估。相比之下，双侧颈动脉狭窄患者双侧CEA的手术指征、手术过程及围手术期管理仍存在争议。在本报告中，我们回顾了过去10年在我院接受双侧CEA的7例患者，涉及临床特征、血管造影结果、手术过程、手术效果及长期预后。患者年龄在52至73岁之间，包括6名男性和1名女性。临床症状方面，1例无症状，2例短暂性脑缺血发作，2例可逆性缺血性神经功能缺损，1例轻度完全性卒中，1例重度完全性卒中。有症状病例优势侧的血管造影颈动脉狭窄程度，3例为50%，1例为70%，2例为90%，4例有溃疡形成。有症状病例非优势侧的狭窄程度，1例为60%，3例为70%，2例为90%，4例有溃疡形成。无症状病例中有1例双侧狭窄80% - 90%。我们对双侧CEA进行分期，有症状病例中除1例外在优势侧先进行，无症状病例在狭窄更严重侧先进行。CEA手术期间，1例放置了外分流管，但所有病例均未使用内分流管。2例患者出现围手术期并发症，1例为短暂性双侧舌下神经麻痹，另1例为局部出血。总体而言，7例患者（共14次连续CEA手术）手术效果均令人满意。无死亡病例，也无永久性并发症。在随访期（平均38.3个月），1例患者同侧颈动脉区域发生脑梗死。根据我们自己的小样本经验及文献报道，双侧颈动脉狭窄的CEA应先在优势侧进行。然后，经过2至6周的一段时间后，再在非优势侧进行CEA。
