摘要目的 探讨血管内开通治疗慢性长节段颈内动脉闭塞的可行性、安全性及有效性.方法 回顾本中心2015年5月至2017年4月经血管内开通治疗的慢性长节段颈内动脉闭塞患者的资料.患者术前符合以下标准:闭塞节段从颈内动脉起始段至岩骨段以上但不累及大脑中动脉、闭塞时间超过3周、有闭塞血管同侧缺血性卒中[Rankin修订量表(mRS)评分≤3分]或短暂性脑缺血发作、有同侧脑组织灌注[达峰时间(TTP)或平均通过时间(MTT)、脑血流量(CBF)]下降.共11例患者纳入分析.分析指标包括患者一般基线资料、影像资料、手术情况及临床、影像随访结果,临床随访指标包括卒中复发情况、临床症状改变情况,影像随访指标是治疗血管的再狭窄或再闭塞.结果 11例患者中9例成功开通血管,2例因导丝头端探至海绵窦段无法到达远端真腔而放弃开通.开通成功的患者中6例于术后1周内复查MR灌注扫描,TTP、MTT、CBF均较术前明显改善;术中1例出现血栓移位导致小分支栓塞,行机械拉栓,术后无明显症状,围手术期未出现症状性卒中或死亡.开通成功患者均获得临床随访,中位随访时间10个月(4~28个月),无缺血性卒中复发或死亡,7例临床症状(肢体活动、言语、非特异性症状如头痛头晕)有不同程度的改善;5例获得影像随访,平均随访时间6个月,均未出现再闭塞.结论 慢性长节段颈内动脉闭塞血管内开通手术安全性及短期效果良好,长期效果有待进一步验证.

abstractsObjective To explore the feasibility,safety and effect of endovascular revascularization for chronic long segment internal carotid artery occlusion. Methods The cases of chronic long segment internal carotid artery occlusion who were treated by endovascular revascularization in our center from May 2015 to April 2017 were reviewed. Eleven cases met the inclusion criteria:the duration of the occlusion was more than three weeks and the segment of the occlusion was beyond the petrosal segment of internal carotid arteries from the initial segment. All of the cases had the related symptoms and had declining cerebral perfusion. The analysis index included:baseline information,radiological information,perioperative results, clinical follow-up and imaging follow-up. The imaging follow-up index were the re-stenosis or re-occlusion of the revascularized artery. Results The occlusion was recanalized successfully in 9 of 11 patients,the two procedures were abandoned after repeated attempts and the guide wire could not reach the true lumen when navigating in the cavernous segment. Six cases of the nine successfully recanalized cases accepted perfusion-weighted imaging scan. Cerebral perfusion of all the cases were improved. Thrombus shifting was observed in one case and occluded a subbranch,mechanical thrombectomy was performed successfully,the case was recovered well without sequela. No symptomatic stroke or death was happened in the perioperative period. All of the nine cases who successfully recanalized acquired clinical follow-up,median follow-up time was ten months(4—28 months). No ischemic stroke and death happened after the procedures. Seven of nine cases improved in the clinical symptoms. Five cases accepted the imaging follow-up. The meantime was six months. No re-occlusion was happened. Conclusions Endovascular revascularization for chronic long segment internal carotid artery occlusion is feasible,safe,and short-term effective. More clinical research is needed to verify the long-term effect.