摘要目的 初步探讨复合手术治疗慢性症状性颈内动脉闭塞的可行性和安全性.方法 回顾性收集聊城市脑科医院神经外科自2016年4月至2018年12月采用颈动脉内膜剥脱术(CEA)+透视下双腔Fogarty球囊导管(3F)取栓术(必要时予支架植入)治疗的9例慢性症状性颈内动脉闭塞(均经数字减影血管造影检查证实为颈内动脉起始处节段性闭塞)患者的临床资料,分析其血管再通情况及围手术期、随访期并发症发生情况.结果 采用CEA+双腔Fogarty球囊导管(3F)取栓治疗5例,取栓后再行支架植入治疗4例.术后颈内动脉即刻通畅9例.术后30 d内3例发生脑过度灌注综合征,给予严格控制血压、适当脱水后症状逐步缓解;9例患者均无脑出血、脑梗死、神经功能损伤等严重并发症发生.术后随访4～36个月,无新发脑梗死或死亡患者,未出现再闭塞情况;1例出现支架内轻度狭窄(50％),无明显相关症状,继续药物治疗;1例术后半年出现1次短暂性脑缺血发作.结论 复合手术是治疗慢性症状性颈内动脉闭塞的有效方法,但术前需要进行全面的评估,谨慎地选择患者,制定个体化的治疗方案.

abstractsObjective To investigate the feasibility and safety of hybrid surgery in treatment of chronic symptomatic internal carotid artery occlusion.MethodsFrom April 2016 to December 2018, 9 patients with chronic symptomatic internal carotid artery occlusion confirmed by digital subtraction angiography were treated with carotid endarterectomy (CEA)+double chamber Fogarty balloon (3F) embolectomy or stent implantation when necessary. The clinical data of these patients were retrospectively analyzed. Vascular recanalization and complications during perioperative period and follow-up of the patients were analyzed.ResultsCEA+double chamber Fogarty balloon (3F) thrombectomy was performed in 5 patients; and stent placement was performed in 4 patients after Fogarty balloon thrombectomy. The internal carotid arteries of all 9 patients were unobstructed immediately during the operation. Postoperative hyperperfusion syndrome occurred in 3 patients; blood pressure was strictly controlled and the symptoms gradually relieved after proper dehydration. No serious complications such as cerebral hemorrhage, cerebral infarction, or nerve injury occurred. The duration of follow-up was 4-36 months; no patient developed a new stroke or death; no re-occlusion appeared; but one mild restenosis (50％) was detected. one patient suffered from a TIA attack 6 months after operation. ConclusionHybrid surgery is an effective method for treatment of chronic symptomatic internal carotid artery occlusion; however, preoperative evaluation and selection of patients should be carefully; individualized treatment plans should be developed.