Vale F L, Fisher W S, Jordan W D, Palmer C A, Vitek J
Division of Neurosurgery, University of Alabama at Birmingham, 35294-3295, USA.
J Neurosurg. 1997 Dec;87(6):940-3. doi: 10.3171/jns.1997.87.6.0940.
Carotid endarterectomy (CEA) is the treatment of choice for asymptomatic and symptomatic disease causing greater than 60% internal carotid artery (ICA) stenosis. Recently, percutaneous transluminal angioplasty (PTA) with stent placement has been investigated as a therapeutic option for the treatment of ICA stenosis. In this report the authors document CEA performed after PTA with stent placement and describe the pathological findings. A standard CEA was performed. The surgical intervention was more difficult secondary to the following variables: the length of the exposure necessary to dissect out the metallic stent, the difficulty with opening and cutting the artery, and the care required to remove the stent to avoid vessel wall perforation. Pathological examination of the specimen demonstrated classic atherosclerotic changes revealing persistence of native disease. The metallic stent was embedded within the plaque. Many questions remain unanswered regarding the physiological and biological changes that occur in the carotid vessel wall after PTA with stent placement. It is concluded that CEA of a stent-containing carotid artery is feasible and should be considered as an alternative when recurrent stenosis occurs after PTA.
颈动脉内膜切除术（CEA）是治疗导致颈内动脉（ICA）狭窄超过60%的无症状和有症状疾病的首选治疗方法。最近，经皮腔内血管成形术（PTA）联合支架置入术已被研究作为治疗ICA狭窄的一种治疗选择。在本报告中，作者记录了PTA联合支架置入术后进行的CEA，并描述了病理结果。进行了标准的CEA。由于以下变量，手术干预更加困难：解剖出金属支架所需的暴露长度、打开和切开动脉的困难以及移除支架以避免血管壁穿孔所需的小心操作。标本的病理检查显示出典型的动脉粥样硬化变化，揭示了原有疾病的持续存在。金属支架嵌入斑块内。关于PTA联合支架置入术后颈动脉血管壁发生的生理和生物学变化，许多问题仍未得到解答。结论是，对含支架的颈动脉进行CEA是可行的，当PTA后发生复发性狭窄时应考虑将其作为一种替代方法。
