Vishteh A G, Marciano F F, David C A, Schievink W I, Zabramski J M, Spetzler R F
Division of Neurological Surgery, Barrow Neurological Institute, Mercy Healthcare Arizona, Phoenix, USA.
Neurosurgery. 1998 Oct;43(4):761-7; discussion 767-8. doi: 10.1097/00006123-199810000-00016.
Surgical management of traumatic internal carotid artery (ICA) dissection remains controversial. Therefore, the delayed outcomes and graft patency rates of patients who underwent bypass procedures for symptomatic traumatic ICA dissection were studied.
Between September 1989 and August 1996, 13 patients (9 male and 4 female patients; mean age, 30.6 yr) underwent 16 revascularization procedures for symptomatic traumatic ICA dissection. The duration of clinical follow-up averaged 47.3 months (range, 12-94 mo) from the date of diagnosis. The duration of radiographic follow-up (catheter or magnetic resonance angiography, duplex Doppler ultrasonography) averaged 24 months (range, 12-60 mo).
ICA dissection was caused by blunt (n = 11) or penetrating trauma (n = 2). Associated angiographic abnormalities included seven ipsilateral ICA occlusions, six dissecting aneurysms, two carotid-cavernous fistulae, and six contralateral traumatic ICA dissections. Patients requiring early revascularization (n = 6) underwent bypass procedures an average of 19.2 days after their injuries. Medically managed patients who developed ischemia later were revascularized a mean of 7.8 months after injury. The mean Glasgow Coma Scale score at the time of presentation was 10 (range, scores of 6-15), and the mean Glasgow Coma Scale score before revascularization was 14 (range, scores of 9-15). There were 14 saphenous vein ICA bypasses (8 cervical-to-petrous, 3 cervical-to-middle cerebral artery, 3 petrous-to-supraclinoid) and 2 superficial temporal artery-to-middle cerebral artery bypasses. There was one early postoperative graft occlusion, which responded to surgical thrombectomy. One patient with multiple other traumatic injuries died as a result of a pulmonary embolus 12 months after revascularization. All remaining patients had Glasgow Outcome Scale scores of 5, with patent bypass grafts confirmed during follow-up.
Revascularization for persistently symptomatic traumatic ICA dissection eliminated ischemia and was associated with excellent long-term outcomes and graft patency rates.
创伤性颈内动脉（ICA）夹层的外科治疗仍存在争议。因此，我们对因症状性创伤性ICA夹层而接受搭桥手术患者的延迟结局和移植物通畅率进行了研究。
1989年9月至1996年8月期间，13例患者（9例男性和4例女性；平均年龄30.6岁）因症状性创伤性ICA夹层接受了16次血运重建手术。从诊断之日起，临床随访时间平均为47.3个月（范围12 - 94个月）。影像学随访（导管或磁共振血管造影、双功多普勒超声检查）时间平均为24个月（范围12 - 60个月）。
ICA夹层由钝性创伤（n = 11）或穿透性创伤（n = 2）引起。相关的血管造影异常包括7例同侧ICA闭塞、6例夹层动脉瘤、2例颈动脉海绵窦瘘和6例对侧创伤性ICA夹层。需要早期血运重建的患者（n = 6）在受伤后平均19.2天接受搭桥手术。后期出现缺血的保守治疗患者在受伤后平均7.8个月进行血运重建。就诊时格拉斯哥昏迷量表平均评分为10分（范围6 - 15分），血运重建前格拉斯哥昏迷量表平均评分为14分（范围9 - 15分）。有14例大隐静脉ICA搭桥（8例颈 - 岩骨段、3例颈 - 大脑中动脉段、3例岩骨 - 床突上段）和2例颞浅动脉 - 大脑中动脉搭桥。术后早期有1例移植物闭塞，经手术取栓后恢复通畅。1例伴有多处其他创伤的患者在血运重建12个月后因肺栓塞死亡。其余所有患者格拉斯哥预后量表评分为5分，随访期间证实搭桥移植物通畅。
对持续有症状的创伤性ICA夹层进行血运重建可消除缺血，且与良好的长期结局和移植物通畅率相关。
