Intravascular treatment of complex symptomatic severe carotid stenosis
10.3760/cma.j.cn311847-20200410-00141
- VernacularTitle:复杂类型症状性颈动脉重度狭窄的血管内治疗
- Author:
Tao XIN
1
;
Yuan PAN
;
Xiliang HE
;
Fan YANG
;
Li DU
Author Information
1. 266071 山东省青岛，解放军第九七一医院神经外科
- Publication Type:Journal Article
- Keywords:
Carotid artery;
Severe stenosis;
Carotid artery stenting;
Complex type
- From:
Chinese journal of nautical medicine and hyperbaric medicine
2020;27(4):481-485,492
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the characteristics of complex severe symptomatic carotid stenosis, and to summarize the surgical techniques of endovascular stent treatment.Methods:A total of 36 cases of complex carotid stenosis with stenosis greater than 90% from January 2013 to July 2019 were selected, among which 22 patients with subtotal occlusion with stenosis of 95%~99%, 6 patients with contralateral internal carotid artery occlusion, 4 elderly patients with severe twisted aortic arch and carotid artery, and 4 patients with angular distortions of internal carotid artery that were too close at the stenosis distal end. The characteristics of pathological change and the state of cerebral blood flow compensation under digital subtraction angiography (DSA) of these 4 above-mentioned complex types were analyzed. The techniques of endovascular surgery were summarized, focusing on the individualized surgical plan, perioperative management, patients′ tolerance, revascularization structure change, complication control, and the occurrence of restenosis and other related ischemic cerebrovascular events during the 1-year postoperative follow-up.Results:Among the cases treated with subtotal occlusion by carotid artery stenting (CAS) with proximal blood flow protection device, 1 case failed and 2 cases received a secondary stent implantation. The surgeries on the patients with contralateral occlusion were performed with preoperative sedation, appropriate elevation of blood pressure, and shortening the vessel occlusion time. The patients with insufficient support due to path distortion received coaxial multi guide wire with multiple switching long sheath assisting technology. Among the patients with angular distortions at stenosis distal end, the stent was successfully released at the proximal in 2 cases, the stent was released across the angle without affecting the blood flow in 1 case, and in 1 case the stent releasing across the angle was given up during the surgery due to the distal artery kinking. A total of 34 surgeries were success (94.4%), with the stenosis severity reducing from (93.1±3.2)% (before) to (21.5±4.8)% (after). In 3 cases, the patients had transient aphasia and contralateral limb hemiplegia and ischemic symptoms during the operation. There was no cerebral hemorrhage, cerebral infarction, or no in-stent restenosis during the one-year follow-up.Conclusion:CAS treatment in complex severe carotid stenosis requires individualized surgical procedures and perioperative management. Appropriate surgical plan can ensure the success and safety of the surgery.
