Bilateral internal carotid artery occlusion: natural history and surgical alternatives
Bilateral internal carotid artery occlusion: natural history and surgical alternatives
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DOI：
10.1016/s0967-2109(98)00072-6
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发表时间：
1998-12-01
期刊：
影响因子：
--
通讯作者：
Copeland, SE
中科院分区：
文献类型：
--
作者：
AbuRahma, AF;Copeland, SE
目的和背景：双侧颈内动脉闭塞是一种非常罕见的疾病，因此，在英文文献中缺乏对这种疾病自然史的研究。本研究的目的是分析双侧颈内动脉闭塞患者的自然病史和手术选择。患者人群和方法：21例双侧颈内动脉闭塞患者，平均年龄61岁（范围48-73岁）。他们的临床表现包括8例半球短暂性脑缺血发作，3例一过性黑蒙，5例中风和5例非半球短暂性脑缺血发作。大多数患者有一个以上的动脉粥样硬化危险因素：吸烟100%，高脂血症14/21（67%），高血压17/21（81%），冠状动脉疾病15/21（71%）和糖尿病7/21（33%）。除了通常的药物治疗外，13名患者接受了外科手术：8名患者接受了颈外动脉内膜切除术，4名患者接受了颈动脉-锁骨下动脉搭桥术（以增加颈外动脉或椎动脉流量，以治疗颈总动脉或锁骨下动脉的狭窄或闭塞），1名患者接受了升主动脉至无名动脉搭桥术。平均随访6年（范围1-11年）时，总死亡率为11/21（52%），手术组为5/13（38%），药物组为6/8（75%）。死亡原因包括7例心肌梗死（手术组4例，药物组3例）和4例中风（手术组1例，药物组3例）。在手术组中，2/13（15%）有晚期神经功能缺损（1例半球短暂性脑缺血发作和1例卒中），而在医疗组中，6/8（75%，3例卒中和3例半球短暂性脑缺血发作）。结论：双侧颈内动脉闭塞有严重的脑血管病，应被视为严重全身性疾病的标志。如果可行，各种脑血管重建手术可能对其中一些患者有益。(C)1998年国际心血管外科学会，Elsevier Science Ltd出版，版权所有。
Purpose and background: Bilateral internal carotid artery occlusion is an extremely rare entity, therefore, studies of the natural history of this disease are lacking in the English literature. The purpose of this study is to analyze the natural history and surgical alternatives for patients with bilateral internal carotid artery occlusion, Patient population and methods: Twenty-one patients with bilateral internal carotid artery occlusion were encountered with a mean age of 61 years (range of 48-73 years). Their clinical presentations included eight with hemispheric transient ischemic attacks, three with amaurosis fugax, five with strokes and five with nonhemispheric transient ischemic attack. Diagnosis was confirmed using carotid duplex ultrasound and angiography, The majority of patients had more than one risk factor for atherosclerosis: smoking in 100%, hyperlipidemia in 14/21 (67%), hypertension in 17/21 (81%), coronary artery disease in 15/21 (71%) and diabetes mellitus in 7/21 (33%). In addition to the usual medical treatment, 13 patients underwent surgical intervention: eight had an external carotid endarterectomy, four had a carotid-subclavian bypass (to increase external carotid or vertebral flow for tight stenosis or occlusion of the common carotid or subclavian artery) and one patient had an ascending aorta to innominate artery bypass. At a mean follow-up of 6 years (range 1-11 years), the overall mortality rates were 11/21 (52%), in the surgical group it was 5/13 (38%) and 6/8 (75%) in the medical group. The causes of death included seven myocardial infarctions (four in the surgical group and three in the medical group) and four strokes (one in the surgical group and three in the medical group). In the surgical group, 2/13 (15%) had late neurological deficits (one hemispheric transient ischemic attach and one stroke), in contrast to 6/8 (75%, three strokes and three hemispheric transient ischemic attacks) in the medical group. Conclusions: Bilateral internal carotid artery occlusions have grave prognoses and should be considered a marker for severe systemic disease, Various cerebrovascular reconstructive procedures, if feasible, may be beneficial for some of these patients. (C) 1998 The international Society for Cardiovascular Surgery, Published by Elsevier Science Ltd, All rights reserved.