Sottiurai V S, Herbert L, Hatter D
Department of Surgery, Louisiana State University School of Medicine, New Orleans 70112-2822, USA.
J Vasc Surg. 1997 Jul;26(1):160-3. doi: 10.1016/s0741-5214(97)70163-0.
Extracranial-intracranial (EC-IC) bypass grafting procedures were specially designed for treatment of bilateral internal carotid artery occlusion. When performed in an expeditious manner, EC-IC bypass procedures have produced effective and durable results, despite the recent disfavor given to this procedure. This communication reports a 68-year-old white man who developed generalized cerebral ischemia manifested as confusion, incoherence, disorientation, ataxia, and numerous episodes of syncope daily. A cerebral angiogram revealed bilateral external carotid arteries and left solitary vertebral artery critical stenosis. Transcranial Doppler study demonstrated reduction of cerebral and vertebral-basilar perfusion. However, the patient's EC-IC bypass graft had remained patent since 1985. The patient's recurrent symptoms of global ischemia and syncope resolved after carotid endarterectomy, vein patch external carotid artery, and vertebral-to-common carotid artery transposition. This report reiterates the value of the EC-IC bypass procedure and presents the surgical management of symptomatic external carotid and vertebral artery stenosis in patients after EC-IC bypass procedures.
颅外-颅内（EC-IC）搭桥手术是专门为治疗双侧颈内动脉闭塞而设计的。尽管最近该手术不太受青睐，但如果以快速的方式进行，EC-IC搭桥手术已产生了有效且持久的效果。本报告介绍了一名68岁的白人男性，他出现了全身性脑缺血，表现为意识模糊、语无伦次、定向障碍、共济失调以及每天多次晕厥发作。脑血管造影显示双侧颈外动脉和左侧孤立椎动脉严重狭窄。经颅多普勒研究表明脑和椎基底灌注减少。然而，自1985年以来，该患者的EC-IC搭桥移植物一直保持通畅。在进行颈动脉内膜切除术、静脉补片颈外动脉以及椎动脉至颈总动脉转位后，患者反复出现的全身性缺血和晕厥症状得到缓解。本报告重申了EC-IC搭桥手术的价值，并介绍了EC-IC搭桥手术后有症状的颈外动脉和椎动脉狭窄患者的手术管理方法。
