摘要
目的探讨伴颅内低灌注的慢性颈内动脉闭塞患者血管再通治疗的临床疗效。方法回顾性分析2020年6月至2024年6月接受血管开通治疗的72例慢性颈内动脉闭塞伴低灌注患者的临床资料。结果Hasan分型A型37例,B型22例,C型11例,D型2例。13例采用颈动脉内膜斑块剥脱术治疗(CEA组),19例采用颈动脉支架植入术治疗(CAS组),40例采用复合手术治疗(复合组)。53例术后即刻造影显示血管再通,总血管再通率为73.61%;其中CEA组为76.92%(10/13)、CAS组为68.42%(13/19)、复合组为75.00%(30/40),三组血管再通率无统计学差异(P=0.828);Hasan分型A型、B型、C型、D型血管再通率分别为83.78%(31/37)、72.72%(16/22)、54.55%(6/11)、0%。Hasan分型A、B型血管再通率(79.66%)明显高于Hasan分型C、D型(46.15%;P=0.033)。CEA组术后并发症发生率[7.69%(1/13)]低于CAS组[31.58%(6/19)]和复合组[22.50%(9/40)],但三组术后并发症发生率无统计学差异(P=0.320)。53例术后随访6个月,其中CEA组10例,CAS组13例,复合组30例;CEA组、CAS组、复合组术后再狭窄发生率分别为0%、7.69%(1/13)、6.67%(2/30),三组术后再狭窄发生率无统计学差异(P>0.999);CEA组、CAS组、复合组预后良好(mRS评分≤2分)率分别为90.00%(9/10)、92.31%(12/13)、86.67%(26/30),三组预后良好率无统计学差异(P>0.999)。结论伴颅内低灌注的慢性颈内动脉闭塞患者进行血管再通治疗是一种安全有效的治疗方式,短期随访结果满意,尤其是Hasan分型A、B型患者。CEA、CAS及复合手术均可以获得良好的治疗效果,可根据患者具体情况选择血管开通方式。
Objective To investigate the clinical efficacy of revascularization therapy for chronic internal carotid artery occlusion with intracranial hypoperfusion.Methods The clinical data of 72 patients with chronic internal carotid artery occlusion with intracranial hypoperfusion who underwent vascular recanalization therapy between June 2020 and June 2024 were retrospectively analyzed.Results According to the Hasan classification,there were 37 cases of type A,22 of type B,11 of type C,and 2 of type D.Among them,13 patients were treated with carotid endarterectomy(CEA group),19 with carotid artery stenting(CAS group),and 40 with hybrid surgery(hybrid group).Immediate postoperative angiography showed successful vascular recanalization in 53 cases,yielding an overall recanalization rate of 73.61%.The recanalization rates were 76.92%(10/13)in the CEA group,68.42%(13/19)in the CAS group,and 75.00%(30/40)in the hybrid group,with no statistically significant difference among the three groups(P=0.828).The recanalization rates for Hasan type A,B,C,and D were 83.78%(31/37),72.72%(16/22),54.55%(6/11),and 0%,respectively.The recanalization rate in patients with Hasan types A and B(79.66%)was significantly higher than that in those with types C and D(46.15%;P=0.033).The incidence of postoperative complications in the CEA group[7.69%(1/13)]was lower than that in the CAS group[31.58%(6/19)]and the hybrid group[22.50%(9/40)],but no statistically significant difference was observed among the three groups(P=0.320).A 6-month postoperative follow-up was conducted for the 53 patients with successful recanalization,including 10 in the CEA group,13 in the CAS group,and 30 in the hybrid group.The incidence of postoperative restenosis was 0%in the CEA group,7.69%(1/13)in the CAS group,and 6.67%(2/30)in the hybrid group,with no statistically significant difference among the groups(P>0.999).The rates of favorable prognosis(mRS score≤2)were 90.00%(9/10)in the CEA group,92.31%(12/13)in the CAS group,and 86.67%(26/30)in the hybrid group,with no statistically significant difference(P>0.999).Conclusion Vascular recanalization therapy is a safe and effective treatment for patients with chronic internal carotid artery occlusion with intracranial hypoperfusion,with satisfactory short-term follow-up outcomes,particularly in patients with Hasan types A and B.CEA,CAS,and hybrid surgery can all achieve good outcomes,and the recanalization method should be chosen according to the specific condition of the patient.
作者
张晓杰
买买提力·艾沙
卡合尔曼·卡德尔
姜世豪
郭珂
王凯
尼扎米丁江·热夏提
成晓江
ZHANG Xiao-jie;MAIMAITILI Aisha;KAHEERMAN Kadeer;JIANG Shi-hao;GUO Ke;WANG Kai;NIZHAMIDINGJIANG Rexiati;CHENG Xiao-jiang(Department of Neurosurgery,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)
出处
《中国临床神经外科杂志》
2025年第8期449-456,共8页
Chinese Journal of Clinical Neurosurgery
基金
省部共建中亚高发病成因与防治国家重点实验室开放课题(SKL-HIDCA-2022-NKX)。
关键词
慢性颈内动脉闭塞
颅内低灌注
动脉内膜斑块剥脱术
颈动脉支架植入术
复合手术
疗效
Chronic internal carotid artery occlusion
Intracranial hypoperfusion
Carotid endarterectomy
Carotid artery stenting
Hybrid surgery
Clinical efficacy
