頸內(nèi)動(dòng)脈假性閉塞手術(shù)治療的單中心經(jīng)驗(yàn)總結(jié)

嚴(yán) 棟 唐 驍 符偉國(guó) 史振宇 王利新 林長(zhǎng)潑 唐涵斐 劉國(guó)偉 郭大喬

(復(fù)旦大學(xué)附屬中山醫(yī)院血管外科-復(fù)旦大學(xué)血管外科研究所 上海 200032)

頸內(nèi)動(dòng)脈假性閉塞手術(shù)治療的單中心經(jīng)驗(yàn)總結(jié)

嚴(yán) 棟 唐 驍 符偉國(guó) 史振宇 王利新 林長(zhǎng)潑 唐涵斐 劉國(guó)偉 郭大喬△

(復(fù)旦大學(xué)附屬中山醫(yī)院血管外科-復(fù)旦大學(xué)血管外科研究所 上海 200032)

目的 評(píng)價(jià)頸內(nèi)動(dòng)脈假性閉塞(atheromatous pseudo-occlusion,APO)手術(shù)治療的安全性及有效性。方法 對(duì)復(fù)旦大學(xué)附屬中山醫(yī)院2011年12月至2016年6月間接受頸動(dòng)脈內(nèi)膜切除術(shù)的頸動(dòng)脈狹窄患者資料進(jìn)行回顧性分析,其中研究組為APO患者32例,對(duì)照組為重度狹窄(70%～99%)患者124例。對(duì)兩組圍手術(shù)期各主要及次要并發(fā)癥、隨訪中的同側(cè)缺血性腦卒中復(fù)發(fā)率、再狹窄率及死亡率進(jìn)行比較。結(jié)果 圍手術(shù)期主要并發(fā)癥:APO組發(fā)生心梗1例(3.1%),無(wú)缺血性腦卒中、腦出血及死亡病例;對(duì)照組發(fā)生缺血性腦卒中2例(1.4%),心肌梗死6例(4.2%),死亡1例(0.7%)。次要并發(fā)癥:APO組發(fā)生切口滲血1例(3.1%),肺部感染2例(6.3%),高灌注綜合征2例(6.3%);對(duì)照組發(fā)生切口滲血3例(2.1%),切口感染2例(1.4%),肺部感染4例(2.8%),顱神經(jīng)損傷2例(1.4%),高灌注綜合征2例(1.4%)。術(shù)后隨訪6～60個(gè)月,平均隨訪(35.3±17.5)個(gè)月。APO組1例(3.1%)同側(cè)缺血性腦卒中復(fù)發(fā),4例(12.5%)發(fā)生再狹窄,死亡3例(9.4%),死因均非神經(jīng)系統(tǒng)疾病。對(duì)照組同側(cè)缺血性腦卒中復(fù)發(fā)8例(5.6%),再狹窄9例(6.3%),死亡8例(5.6%)。兩組間圍手術(shù)期各主要及次要并發(fā)癥,隨訪中的同側(cè)缺血性腦卒中復(fù)發(fā)率、再狹窄率、死亡率的差異均無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論 對(duì)APO患者行頸動(dòng)脈內(nèi)膜切除術(shù)治療安全有效,圍手術(shù)期及隨訪結(jié)果滿意。

動(dòng)脈假性閉塞; 頸動(dòng)脈內(nèi)膜切除術(shù); 缺血性腦卒中

頸內(nèi)動(dòng)脈假性閉塞(atheromatous pseudo-occlusion,APO)是指頸內(nèi)動(dòng)脈重度粥樣硬化性狹窄伴有狹窄遠(yuǎn)端頸內(nèi)動(dòng)脈管腔變細(xì)[1](圖1)。頸動(dòng)脈內(nèi)膜剝脫術(shù)(carotid endarterectomy,CEA)經(jīng)過(guò)60余年的推廣和發(fā)展,現(xiàn)已成為顱外頸動(dòng)脈粥樣硬化性狹窄的標(biāo)準(zhǔn)手術(shù)方法,近遠(yuǎn)期療效滿意[2]。然而APO病變不同于一般意義上的重度狹窄病變(70%～99%)及完全閉塞病變,有著自身的特點(diǎn)。對(duì)于APO患者行CEA治療的效果目前尚存在爭(zhēng)議[3]。本文研究目的即為探討APO病變行CEA的安全性及有效性。

資 料 和 方 法

病例資料 對(duì)2011年12月至2016年6月因頸動(dòng)脈狹窄于復(fù)旦大學(xué)附屬中山醫(yī)院行CEA治療的患者資料進(jìn)行回顧性分析。CEA治療的適應(yīng)證為:(1)癥狀性頸動(dòng)脈狹窄直徑狹窄率>50%,無(wú)癥狀性頸動(dòng)脈狹窄直徑狹窄率>70%[4];(2)年齡>18歲;(3)可耐受阿司匹林、氯吡格雷、肝素等藥物,各項(xiàng)術(shù)前檢查無(wú)明顯手術(shù)禁忌。排除標(biāo)準(zhǔn):(1)頸部放療史;(2)頸部手術(shù)史;(3)3周內(nèi)嚴(yán)重缺血性腦卒中發(fā)作;(4)全身情況差,不能耐受手術(shù)或麻醉。頸動(dòng)脈直徑狹窄率,頸動(dòng)脈再狹窄率的計(jì)算方法參考北美癥狀性頸動(dòng)脈內(nèi)膜切除術(shù)試驗(yàn)(North American Symptomatic Carotid Endarterectomy Trial,NASCET)的標(biāo)準(zhǔn)[5]。頸動(dòng)脈再狹窄定義為術(shù)后超過(guò)30天發(fā)生的頸動(dòng)脈直徑狹窄率>70%或完全閉塞[6]。所有患者治療前簽署知情同意書。

A:With distal lumen full collapse;B:Pseudo-occlusion of internal carotid artery without distal lumen full collapse.

圖1 APO病變血管造影圖像

Fig 1 Angiographic image of APO lesions

2011年12月至2016年6月共232例頸動(dòng)脈狹窄患者于我院接受CEA治療,其中APO 32例作為研究組,重度狹窄(70%～99%)124例作為對(duì)照組。所有患者的術(shù)前資料見(jiàn)表1,兩組患者的一般資料特征差異在治療前無(wú)統(tǒng)計(jì)學(xué)意義。

影像學(xué)評(píng)估 所有患者在術(shù)前均行頸動(dòng)脈超聲,頸椎動(dòng)脈CT血管造影(computed tomography angiography,CTA)明確狹窄程度及病變情況。頸動(dòng)脈超聲或CTA懷疑為APO則進(jìn)一步行頸動(dòng)脈及顱內(nèi)動(dòng)脈數(shù)字減影血管造影(digital subtraction angiography,DSA)。DSA下滿足以下4條標(biāo)準(zhǔn)中2條即可診斷為APO:(1)患側(cè)頸內(nèi)動(dòng)脈重度狹窄遠(yuǎn)端直徑小于對(duì)側(cè)頸內(nèi)動(dòng)脈遠(yuǎn)端直徑;(2)患側(cè)頸內(nèi)動(dòng)脈重度狹窄遠(yuǎn)端直徑小于或者等于患側(cè)頸外動(dòng)脈直徑;(3)顱內(nèi)血管延遲顯影;(4)患側(cè)顱內(nèi)血管顯影淺淡或由對(duì)側(cè)半球血供代償[1]。術(shù)前及術(shù)后30天內(nèi)行頭顱磁共振檢查明確有無(wú)新發(fā)缺血性腦卒中。

表1 兩組患者術(shù)前一般資料比較

COPD:Chronic obstructive pulmonary disease.

手術(shù)方法 全組患者均在全身麻醉下接受CEA,具體手術(shù)方式可參照之前文獻(xiàn)報(bào)道[7]。打開(kāi)頸動(dòng)脈鞘后顯露頸內(nèi)動(dòng)脈遠(yuǎn)心端,至管腔相對(duì)正常段。予以肝素化并在術(shù)中檢測(cè)激活全血凝固時(shí)間(activated clotting time of whole blood,ACT),控制于200～250 s,阻斷頸內(nèi)動(dòng)脈前常規(guī)誘導(dǎo)性升高收縮壓>150 mmHg (1 mmHg=0.133 kPa,下同)。如術(shù)前影像學(xué)提示對(duì)側(cè)頸內(nèi)動(dòng)脈閉塞或Willis環(huán)不完整,則術(shù)中使用轉(zhuǎn)流管[7]。如術(shù)中斑塊處頸內(nèi)動(dòng)脈直徑<5 mm或動(dòng)脈切開(kāi)長(zhǎng)度大于4 cm,則考慮使用補(bǔ)片成形[7-8]。術(shù)畢開(kāi)放頸動(dòng)脈后予以甘露醇125 mL快速靜滴。

術(shù)后處理 術(shù)后嚴(yán)格監(jiān)測(cè)血壓及神經(jīng)系統(tǒng)變化。如無(wú)禁忌,術(shù)后常規(guī)使用雙聯(lián)抗血小板治療,口服拜阿司匹林100 mg/d及氯吡格雷75 mg/d,雙聯(lián)抗血小板治療,以及他汀類降脂藥物。如收縮壓高于140 mmHg,則使用烏拉地爾等降壓藥物,甘露醇預(yù)防腦水腫等。出院后常規(guī)雙聯(lián)抗血小板治療6個(gè)月,以后終身服用拜阿司匹林100 mg/d。

隨訪 出院后第1、3、6、12個(gè)月行超聲頸動(dòng)脈超聲檢查和神經(jīng)系統(tǒng)評(píng)估,以后每年隨訪1次。如懷疑頸動(dòng)脈再狹窄,則行頸椎動(dòng)脈CTA或血管造影等進(jìn)一步檢查明確。

安全性及有效性評(píng)價(jià) 安全性評(píng)價(jià)以圍手術(shù)期各主要并發(fā)癥(缺血性腦卒中、心梗、死亡)及次要并發(fā)癥[切口滲血、切口感染、肺部感染、顱神經(jīng)損傷、高灌注綜合征(cerebral hyperperfusion syndrome,CHS)等]的發(fā)生率為標(biāo)準(zhǔn)。有效性評(píng)價(jià)以隨訪中的同側(cè)缺血性腦卒中復(fù)發(fā)率,再狹窄率及死亡率為標(biāo)準(zhǔn)。

結(jié) 果

APO組手術(shù)情況 頸動(dòng)脈內(nèi)膜切除術(shù)成功率為100% (32/32)。使用補(bǔ)片血管成形18例(56.25%,18/32),直接縫合14例(43.75%,14/32)。術(shù)中使用轉(zhuǎn)流管8例,轉(zhuǎn)流管組的頸動(dòng)脈阻斷時(shí)間3～7min,平均(4.6±1.4)min;無(wú)轉(zhuǎn)流管組24例,頸動(dòng)脈阻斷時(shí)間19～60min,平均(33.8±9.8)min。

圍手術(shù)期并發(fā)癥情況 主要并發(fā)癥:APO組發(fā)生心梗1例(3.1%),無(wú)缺血性腦卒中及死亡病例;對(duì)照組發(fā)生缺血性腦卒中2例(1.4%),心梗6例(4.3%),死亡1例(0.7%),死亡原因?yàn)榧毙孕墓?。次要并發(fā)癥:APO組發(fā)生切口滲血1例(3.1%),肺部感染2例(6.3%),CHS2例(6.3%);對(duì)照組發(fā)生切口滲血3例(2.1%),切口感染2例(1.4%),肺部感染4例(2.8%),顱神經(jīng)損傷2例(1.4%),CHS2例(1.4%)。兩組之間圍手術(shù)期各主要并發(fā)癥及次要并發(fā)癥發(fā)生率差異無(wú)統(tǒng)計(jì)學(xué)意義(表2)。

表2 兩組患者圍手術(shù)期和隨訪結(jié)果比較

CHS:Cerebral hyperperfnsion syndrome.

隨訪結(jié)果 術(shù)后隨訪6～60個(gè)月,平均隨訪(35.3±17.5)個(gè)月。隨訪中,APO組中1例(3.1%)于術(shù)后30個(gè)月同側(cè)缺血性腦卒中復(fù)發(fā),經(jīng)過(guò)保守治療1個(gè)月后恢復(fù);4例(12.5%)患者發(fā)生無(wú)癥狀性再狹窄,2例分別于術(shù)后12個(gè)月、36個(gè)月經(jīng)超聲診斷為重度狹窄,后經(jīng)DSA證實(shí)為再次APO;1例術(shù)后24個(gè)月超聲診斷為70%直徑狹窄;1例術(shù)后24個(gè)月超聲診斷為完全閉塞,后經(jīng)DSA證實(shí);死亡3例(9.4%),均非神經(jīng)系統(tǒng)原因,1例術(shù)后24個(gè)月死于急性心梗,1例術(shù)后28個(gè)月死于慢性腎功能不全并發(fā)高鉀血癥,1例術(shù)后36個(gè)月死于結(jié)腸癌復(fù)發(fā)。對(duì)照組同側(cè)缺血性腦卒中復(fù)發(fā)8例(5.6%),再狹窄9例(6.3%),死亡8例(5.6%)。生存分析顯示,APO行CEA治療的5年生存率及靶血管通暢率是83.5%和80.8%,頸動(dòng)脈重度狹窄行CEA治療的5年生存率及靶血管通暢率為83.1%和89.8% (圖2,3)。兩組隨訪中的同側(cè)缺血性腦卒中復(fù)發(fā)率、再狹窄率、死亡率的差異均無(wú)統(tǒng)計(jì)學(xué)意義(表2)。APO組除了再狹窄的4例,均可從血管超聲或頸動(dòng)脈CTA觀察到遠(yuǎn)端頸內(nèi)動(dòng)脈不同程度的管腔直徑擴(kuò)張(圖4)。APO組中,直接縫合的14例患者再狹窄率(28.6%,4/4)高于使用補(bǔ)片血管成形的18例患者(0%,0/18),差異有統(tǒng)計(jì)學(xué)意義(圖5)。

Kaplan-Meier curve analysis revealed that the five-year survival rate of the study group and control group was 83.5% and 83.1%respectively (P=0.22).

圖2 兩組患者生存分析

Fig 2 Analysis on survival time of the two groups

Kaplan-Meier curve analysis revealed that the five-year carotid artery patency rate of the study group and control group was 80.8% and 89.8%,respectively (P=0.12).

圖3 兩組患者頸動(dòng)脈通暢率分析

Fig 3 Analysis on carotid artery pantency rate of the two groups

A:Preoperative DSA showed severe stenosis of internal carotid artery with the distal lumen diameter reducing;B:CTA reexamination after 1 years of operation showed that internal carotid artery patency,distal lumen diameter recovery.

圖4 APO典型病例隨訪情況

Fig 4 Follow-up of a typical APO patient

討 論

APO又稱為“頸內(nèi)動(dòng)脈接近閉塞”、“頸內(nèi)動(dòng)脈不完全閉塞”和“頸內(nèi)動(dòng)脈次全閉塞”等[9],可分為伴遠(yuǎn)端管腔完全塌陷和不伴有遠(yuǎn)端管腔完全塌陷兩種類型[10](圖1)。兩種APO類型的差異并無(wú)絕對(duì)標(biāo)準(zhǔn)。APO在國(guó)內(nèi)鮮有相關(guān)報(bào)道[11],國(guó)外文獻(xiàn)報(bào)道APO在頸動(dòng)脈狹窄中的發(fā)生率為0.5%～10%[9]。因此,APO病變并不罕見(jiàn),其病變特點(diǎn)值得臨床醫(yī)師關(guān)注。

Kaplan-Meier curve analysis revealed that the five-year carotid artery patency rate of the patch group and direct suturing group was 100.0% and 61.1%,respectively (P=0.028).

圖5 APO組中補(bǔ)片的使用與通暢率的關(guān)系

Fig 5 Relationship between patch and patency rate in APO group

APO病變的診斷需要與傳統(tǒng)重度狹窄病變(70%～99%)、完全閉塞病變相鑒別。不同于傳統(tǒng)重度狹窄病變,APO病變由于遠(yuǎn)端管腔塌陷,如采用NASCET法,狹窄度將被低估。而且APO病變的狹窄度也無(wú)法用具體數(shù)值來(lái)估計(jì),因此遇到一個(gè)重度狹窄病變,應(yīng)該首先評(píng)估是否為APO。DSA是診斷APO病變的金標(biāo)準(zhǔn)。如果DSA造影時(shí)沒(méi)有足夠時(shí)間的延遲相,APO常常會(huì)被診斷為頸內(nèi)動(dòng)脈完全閉塞。臨床中也常常發(fā)現(xiàn)一些被診斷為完全閉塞的有癥狀的患者往往是APO。造影時(shí)還需要注意將頸外動(dòng)脈分支(如咽升動(dòng)脈)與管腔塌陷的頸內(nèi)動(dòng)脈相鑒別。但DSA因其有創(chuàng)且費(fèi)時(shí)費(fèi)力,臨床上對(duì)頸動(dòng)脈狹窄患者施行頸動(dòng)脈內(nèi)膜切除術(shù),術(shù)前往往只行超聲或CTA檢查,這也會(huì)明顯降低APO病變的診出率。有文獻(xiàn)報(bào)道時(shí)間分辨的四維CTA這項(xiàng)無(wú)創(chuàng)檢查的使用可以準(zhǔn)確識(shí)別APO病變[12],可能在未來(lái)的臨床中有一定的應(yīng)用價(jià)值。

NASCET及歐洲頸動(dòng)脈外科試驗(yàn)(European Carotid Surgery Trail,ECST)中入組了246例APO不伴有遠(yuǎn)端管腔完全塌陷病例,16例APO伴有遠(yuǎn)端管腔塌陷病例[1]。有學(xué)者對(duì)這一亞組的研究發(fā)現(xiàn),如僅行藥物治療APO,3年內(nèi)同側(cè)缺血性腦卒中的發(fā)生率達(dá)15.1%[1]。Johansson等[13]報(bào)道癥狀性頸動(dòng)脈狹窄患者90天內(nèi)腦卒中復(fù)發(fā)率,頸動(dòng)脈狹窄率50%～99%的患者為18%,而APO伴遠(yuǎn)端頸內(nèi)動(dòng)脈完全塌陷的患者則高達(dá)43%。APO病變中遠(yuǎn)端管腔完全塌陷的病變具有更高的缺血性腦卒中復(fù)發(fā)率,可能因?yàn)檠髁繃?yán)重降低而導(dǎo)致局部血液潴留,增加血栓形成和栓塞風(fēng)險(xiǎn)[14]。另外,APO病變中40%的患者將在12個(gè)月內(nèi)發(fā)展為完全閉塞,100%的患者將在34個(gè)月內(nèi)發(fā)展為完全閉塞[15-16]。因此對(duì)于假性閉塞病變應(yīng)盡早手術(shù),以免發(fā)展為完全閉塞后而錯(cuò)失手術(shù)機(jī)會(huì)。

APO病變頸動(dòng)脈遠(yuǎn)端血栓形成風(fēng)險(xiǎn)較一般頸動(dòng)脈重度狹窄病變高。因此在準(zhǔn)備手術(shù)期間,如無(wú)禁忌可予以低分子肝素4 000 U/q 12 h抗凝至手術(shù)前一天。手術(shù)探查頸內(nèi)動(dòng)脈時(shí)應(yīng)該盡量更遠(yuǎn),以防止遠(yuǎn)端合并血栓病變。如有條件可配合術(shù)中超聲進(jìn)行探查。另外,APO病變遠(yuǎn)端由于長(zhǎng)期血流量不足,多已建立良好的側(cè)支循環(huán),因術(shù)中臨時(shí)阻斷而導(dǎo)致腦缺血的可能性較小,很少需作轉(zhuǎn)流。

與頸動(dòng)脈重度狹窄患者相比,APO患者行CEA治療的風(fēng)險(xiǎn)并未明顯升高[17]。我中心對(duì)于APO病變施行CEA治療的32例患者中,圍手術(shù)期僅1例發(fā)生心肌梗死,該患者予以硝酸甘油等保守治療后癥狀好轉(zhuǎn),無(wú)癥狀性缺血性腦卒中或死亡等其他嚴(yán)重并發(fā)癥的發(fā)生。2例發(fā)生顱腦高CHS,表現(xiàn)為煩躁、瞻望等精神癥狀,頭顱CT檢查未發(fā)現(xiàn)腦出血,予以鎮(zhèn)靜藥物后均好轉(zhuǎn)。嚴(yán)密的血壓監(jiān)測(cè)和控制是預(yù)防CHS的基礎(chǔ)[18]。術(shù)后如無(wú)禁忌證使用脫水藥物及小劑量激素可能對(duì)于CHS的預(yù)防亦有幫助。我們還發(fā)現(xiàn)切口滲血1例,清創(chuàng)縫合后愈合良好,肺部感染2例,均經(jīng)過(guò)對(duì)癥保守治療后好轉(zhuǎn)。APO組與對(duì)照組相比,圍手術(shù)期主要及次要并發(fā)癥的發(fā)生無(wú)統(tǒng)計(jì)學(xué)意義,因此CEA治療APO病變是安全的。

32例APO患者CEA術(shù)后隨訪僅1例同側(cè)缺血性腦卒中復(fù)發(fā)。因此CEA對(duì)于預(yù)防APO病變?cè)侔l(fā)缺血性腦卒中的療效令人滿意。本組病例隨訪中發(fā)現(xiàn)4例再狹窄,值得注意的是這4例患者均未使用補(bǔ)片成形。因?yàn)檠a(bǔ)片會(huì)增加感染風(fēng)險(xiǎn)和操作時(shí)間,所以我中心實(shí)施選擇性補(bǔ)片成形策略,即術(shù)中斑塊處頸內(nèi)動(dòng)脈直徑<5 mm或動(dòng)脈切開(kāi)長(zhǎng)度>4 cm時(shí)使用補(bǔ)片成形[7-8]。但是對(duì)于APO病變,遠(yuǎn)端頸內(nèi)動(dòng)脈都有不同程度的變細(xì),補(bǔ)片的使用可能會(huì)有利于遠(yuǎn)端頸內(nèi)動(dòng)脈重塑,降低術(shù)后再狹窄率。因此,我們認(rèn)為APO病變行CEA治療時(shí),應(yīng)更積極地使用血管補(bǔ)片。

APO病變行手術(shù)治療是安全有效的。選擇合適的病例,進(jìn)行個(gè)性化治療,早中期隨訪結(jié)果滿意。但本研究病例數(shù)量有限,且為單中心回顧性分析,所以本研究的結(jié)論尚需要進(jìn)一步的大宗病例研究以及長(zhǎng)期隨訪予以證實(shí)。

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Surgical treatment for atheromatous pseudo-occlusion of the internal carotid artery:a single center experience

YAN Dong, TANG Xiao, FU Wei-guo, SHI Zhen-yu, WANG Li-xin,LIN Chang-po, TANG Han-fei, LIU Guo-wei, GUO Da-qiao△

(DepartmentofVascularSurgery,ZhongshanHospital-InstituteofVascularSurgery,FudanUniversity,Shanghai200032,China)

Objective To investigate the efficacy and safety of surgical treatment for internal carotid artery atheromatous pseudo-occlusion (APO). Methods Clinical data of patients with carotid artery stenosis treated by carotid endarterectomy from Dec.,2011 to Jun.,2016 in Zhongshan Hospital Affiliated to Fudan University were analyzed retrospectively.Carotid endarterectomy were performed in 32 patients with pseudo-occlusion of the internal carotid artery (APO group).And 124 patients with traditional severe stenosis (70%-99%) served as control group.Perioperative major and minor complications,recurrence rate of ipsilateral ischemic stroke,restenosisrate and mortality in follow-up were compared between the two groups. Results Perioperative major complications:one patient (3.1%) developed myocardial infarction in the APO group,no ischemic stroke,cerebral hemorrhage and death cases;2 (1.4%) ischemic stroke cases,6 (4.2%) myocardial infarction cases and 1 (0.7%) death case was found in control group.Perioperative minor complications:1 (3.1%) incision bleeding case,2 (6.3%) pulmonary infection cases,2 (6.3%) cerebral hyperperfusion syndrome cases were found in APO group;3 (2.1%) incision bleeding cases,2 (1.4%) incision infection cases,4 (2.8%) pulmonary infection cases,2 (1.4%) cranial nerve injury cases,2 (1.4%) cerebral hyperperfusion syndrome cases were found in control group.Patients were followed up for 6-60 months,with mean follow-up period of (35.3±17.5) months.During follow-up,1 (3.1%) ipsilateral ischemic stroke recurrence case,4 (12.5%) restenosis cases,and 3 (9.4%) death cases were found in the APO group.And 8 (5.6%) ipsilateral ischemic stroke recurrence cases,9 (6.3%) restenosis cases,8 (5.6%) death cases were found in control group.There were no significant differences in perioperative major and minor complications,recurrence rate of ipsilateral ischemic stroke,restenosis rate and mortality between the two groups. Conclusions Surgical treatment for atheromatous pseudo-occlusion of the internal carotid artery is safe and effective.Perioperative and follow-up results are satisfactory.

atheromatous pseudo-occlusion; carotid endarterectomy; cerebral ischemic stroke

國(guó)家自然科學(xué)基金(81570433);上海市科委基金(14411962300)

R622+.4

A

10.3969/j.issn.1672-8467.2017.04.011

2016-12-30;編輯:沈玲)

△Corresponding author E-mail:guo.daqiao@zs-hospital.sh.cn

*This work was supported by the National Natural Science Foundation of China (81570433) and the Foundation of Science and Technology Commission of Shanghai Municipality (14411962300).