Ballotta E, Abbruzzese E, Thiene G, Bottio T, Dagiau G, Angelini A, Saladini M
Department of General Surgery, University of Padua, School of Medicine, Padova, Italy.
Ann Vasc Surg. 1997 Mar;11(2):120-8. doi: 10.1007/s100169900021.
The purposes of this study are to (1) demonstrate the association of elongations of the internal carotid artery (ICA), that is, kinking, coiling, tortuousity, and angulation, and the neurologic symptoms with high stroke risk; (2) compare the results of the surgical treatment versus the medical treatment alone; (3) contribute to the knowledge of the natural history of these anatomical particularities. From January 1992 to December 1994, 113 patients with ICA kinking, coiling, tortuousity, and angulation were randomized either to surgery (group I, n = 55) or not (group II, n = 58). Patients, who presented a carotid hemodynamically significant lesion (>60%) at the origin and associated distal elongation were excluded. The groups were comparable with regard to sex, age, risk factors for atherosclerosis, associated diseases, symptoms and anatomic feature of the contralateral ICA. Follow-up was obtained in all patients: it consisted of clinical evaluation and Duplex scan control at 3-month intervals during the follow-up period (6-36 months; average, 23). Histologic specimens were obtained in all surgically treated arteries. Early results were excellent: in group I, no patient died, no patient presented major or minor stroke. Only one patient had an immediate transient ischemic attack (TIA) which spontaneously recovered within 24 hours. All symptomatic patients examined the complete disappearance of clinical signs. There were no late deaths due to stroke and no late major or minor neurologic deficit occurred. All reconstructed ICAs were patent. In group II, three patients experienced a major stroke with hemiplegia due to ICA occlusion. Most of the symptomatic patients (37) of group II remained stable, while seven of them had worsening of symptoms and were referred for surgery. To conclude, all surgically treated patients had the complete relief of preoperative neurologic symptoms; none of the medically treated patients had an improvement. Although there was no statistically significant difference between the two groups with regard to stroke risk, three medically treated patients progressed to total occlusion. This suggests that kinking, coiling, tortuousity, and angulations of the ICA are not merely an anatomic curiosity but a potentially disabling, even fatal condition.
（1）证明颈内动脉（ICA）延长，即扭结、盘绕、迂曲和成角与具有高卒中风险的神经症状之间的关联；（2）比较手术治疗与单纯药物治疗的结果；（3）增进对这些解剖学特殊性自然史的认识。1992年1月至1994年12月，113例患有ICA扭结、盘绕、迂曲和成角的患者被随机分为手术组（I组，n = 55）或非手术组（II组，n = 58）。起源处存在颈动脉血流动力学显著病变（>60%）且伴有远端延长的患者被排除。两组在性别、年龄、动脉粥样硬化危险因素、相关疾病、对侧ICA的症状和解剖特征方面具有可比性。所有患者均获得随访：随访包括在随访期（6 - 36个月；平均23个月）内每隔3个月进行临床评估和双功超声扫描检查。所有接受手术治疗的动脉均获取了组织学标本。早期结果极佳：在I组中，无患者死亡，无患者发生大或小卒中。仅1例患者出现即刻短暂性脑缺血发作（TIA），并在24小时内自发恢复。所有有症状的患者检查发现临床体征完全消失。无因卒中导致的晚期死亡，也未发生晚期大或小神经功能缺损。所有重建的ICA均通畅。在II组中，3例患者因ICA闭塞发生伴有偏瘫的大卒中。II组中大多数有症状的患者（37例）病情保持稳定，而其中7例症状加重并被转诊接受手术。总之，所有接受手术治疗患者术前神经症状完全缓解；所有接受药物治疗患者均无改善。尽管两组在卒中风险方面无统计学显著差异，但3例接受药物治疗的患者进展为完全闭塞。这表明ICA的扭结、盘绕、迂曲和成角不仅仅是一种解剖学上的奇特现象，而是一种潜在的致残甚至致命状况。
