Preliminary experiences of management on acute carotid artery occlusion during perioperative period of carotid endarterectomy
10.3760/cma.j.cn115455-20230529-00570
- VernacularTitle:颈动脉内膜剥脱术患者围手术期颈动脉急性闭塞处理方法的探讨
- Author:
Hongwei ZHANG
1
;
Dong ZHANG
;
Xiao MIAO
;
Shaomin WANG
;
Xiguang LIU
;
Yan GU
;
Yong SUN
;
Shiwei YAN
;
Aimin LI
Author Information
1. 徐州医科大学附属连云港医院神经外科，连云港 222002
- Keywords:
Endarterectomy, carotid;
Carotid artery diseases;
Stroke;
Perioperative period;
Multi-mode monitoring
- From:
Chinese Journal of Postgraduates of Medicine
2024;47(11):994-1000
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the treatment and prognosis of acute carotid artery occlusion during perioperative period of carotid endarterectomy (CEA).Methods:The clinical data of 112 carotid artery stenosis patients who underwent CEA from January 2017 to December 2021 in Lianyungang Hospital Affiliated to Xuzhou Medical University were retrospectively analyzed. The patients were followed up at 6 to 9 months after surgery, the clinical prognosis was evaluated by Glasgow outcome score (GOS), and the head and neck CT angiography (CTA) was performed.Results:Among the 112 patients, 5 patients underwent acute carotid artery occlusion during the perioperative period, including 1 case of intraoperative acute occlusion of internal carotid artery and 1 case of intraoperative internal carotid artery combined with external carotid artery cute occlusion, both of them were re-sutured, and multi-mode monitoring showed that each carotid artery was unobstructed; 2 cases of intraoperative external carotid artery occlusion, no re-suture was performed during the operation; 1 case of intraoperative monitoring showed no obvious abnormality, and the contralateral limb hemiplegia was observed after surgery, and the muscle strength was grade 1, the carotid color Doppler ultrasound showed the occlusion of the internal carotid artery on the operation side. The CT and CTA examination showed focal infarction and common carotid artery on the operation side, and drugs and conservative treatment were given. The follow-up result: GOS 5 scores was in 4 cases, and 4 scores in 1 case; the muscle strength of hemiplegia patient recovered to grade 4; head and neck CTA examination, except for 1 case of common arterial occlusion, the other 4 cases showed no special abnormality.Conclusions:Intraoperative acute carotid artery occlusion can be detected timely by intraoperative multi-mode hemodynamic monitoring during CEA. Vascular recanalization after acute occlusion is possible by adopting active and effective treatment methods, the occurrence of postoperative ischemic stroke can be effectively prevented and the prognosis of patients can be improved.
