Hacein-Bey L, Connolly E S, Duong H, Vang M C, Lazar R M, Marshall R S, Young W L, Solomon R A, Pile-Spellman J
Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
Neurosurgery. 1997 Dec;41(6):1225-31; discussion 1231-4. doi: 10.1097/00006123-199712000-00001.
Hunterian ligation of the internal carotid artery (ICA) is an accepted treatment for inoperable carotid aneurysms. Preliminary extracranial-intracranial (EC-IC) bypass surgery is required in some patients. The reported incidence of thromboembolic and ischemic complications remains significant for these patients, despite a variety of advocated management strategies. We present our treatment paradigm.
Between April 1992 and March 1997, nine patients with inoperable ICA aneurysms were treated using EC-IC bypass surgery and then permanent endovascular ICA occlusion. All of the patients except one had been selected for bypass surgery on the basis of failing results of the ICA test occlusion with hypotensive challenge. ICA occlusion was performed by endovascular means and was delayed after bypass surgery was performed by a mean of 6 days (range, 2-20 d). All patients were managed in the intensive care unit after ICA occlusion.
Clinical improvement was noted in all patients (mean follow-up, 21 mo; range, 3-42 mo). There were no major complications. Aneurysmal thrombosis was confirmed in all patients. Although ICA occlusion was delayed after bypass surgery, only one bypass was noted to be occluded. The occluded bypass occurred in a patient who subsequently underwent successful ICA occlusion. This patient was thought to have been improperly selected for bypass surgery.
Certain carotid aneurysms can be effectively managed with hunterian ICA ligation. After preliminary identification of patients with borderline cerebrovascular reserve as candidates for EC-IC bypass surgery, close attention to the following points may help enhance clinical outcome: 1) excellence in surgical technique for EC-IC bypass surgery, 2) occlusion of the parent vessel as close to the aneurysm neck as possible by endovascular means, and 3) judicious postoperative combination of anticoagulation, fluid, and pressure management.
颈内动脉（ICA）的亨特结扎术是治疗无法手术的颈动脉动脉瘤的一种公认方法。部分患者需要先行颅外-颅内（EC-IC）旁路手术。尽管有多种推荐的管理策略，但这些患者血栓栓塞和缺血性并发症的报告发生率仍然很高。我们介绍我们的治疗模式。
1992年4月至1997年3月，9例无法手术的ICA动脉瘤患者接受了EC-IC旁路手术，然后进行永久性血管内ICA闭塞术。除1例患者外，所有患者均因ICA试验性闭塞加降压试验结果不佳而被选行旁路手术。ICA闭塞通过血管内方法进行，在旁路手术后平均延迟6天（范围2-20天）进行。ICA闭塞术后所有患者均在重症监护病房进行管理。
所有患者临床症状均有改善（平均随访21个月；范围3-42个月）。无重大并发症。所有患者均证实动脉瘤血栓形成。尽管ICA闭塞在旁路手术后延迟进行，但仅发现1条旁路闭塞。闭塞的旁路发生在1例随后成功进行ICA闭塞的患者身上。该患者被认为不适合选行旁路手术。
某些颈动脉动脉瘤可通过亨特ICA结扎术有效治疗。在初步确定脑血管储备临界患者作为EC-IC旁路手术候选者后，密切关注以下几点可能有助于提高临床疗效：1）EC-IC旁路手术的精湛手术技术；2）通过血管内方法尽可能靠近动脉瘤颈部闭塞供血血管；3）术后明智地联合应用抗凝、液体和压力管理。
