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Abstract：
To investigate the significance of atherosclerotic plaque location in hybrid surgery comprising both endovascular recanalization approaches and carotid endarterectomy for symptomatic atherosclerotic non-acute long-segment occlusion of the internal carotid artery (ICA), 162 patients were enrolled, including 120 (74.1%) patients in the proximal plaque group and 42 (25.9%) in the distal plaque group. Surgical recanalization was performed in all patients, with successful recanalization in 119 (99.2%) patients in the proximal and 39 (92.9%) in the distal plaque group. The total successful recanalization rate was 97.5% (158/162) with a failure rate of 2.5% (4/162). Periprocedural complications occurred in 5 (4.2% or 5/120) patients in the proximal plaque group, including neck infection in two (1.7%), recurrent nerve injury in 1 (0.8%), and laryngeal edema in 2 (1.7%), and 2 (4.8%) in the distal plaque group, including femoral puncture infection in 2 (4.8%). No severe complications occurred in either group. Univariate analysis showed plaque location was a significant (P = 0.018) risk factor for successful recanalization, and multivariate analysis indicated that the plaque location remained a significant independent risk factor for recanalization success (P = 0.017). In follow-up 6-48 months after the recanalization surgery, reocclusion occurred in two (2.8%) patients in the proximal plaque group and 4 (13.3%) in the distal plaque group. In conclusion, although hybrid surgery achieves similar outcomes in patients with ICA occlusion caused by either proximal or distal atherosclerotic plaques, plaque location may be a significant risk factor for successful recanalization of symptomatic non-acute long-segment ICA occlusion.
摘要：
探讨动脉粥样硬化斑块位置在包括血管内再通和颈动脉内膜切除术的混合手术治疗症状性动脉粥样硬化非急性颈内动脉长段闭塞（ICA）中的意义。162名患者入选，其中近端斑块组120例(74.1%),远端斑块组42例(25.9%).所有患者均进行了手术再通，119例(99.2%)近端和39例(92.9%)远端斑块组患者成功再通。总成功再通率为97.5%(158/162)，失败率为2.5%(4/162)。近端斑块组5例（4.2%或5/120）患者发生围手术期并发症，包括颈部感染2人(1.7%)，复发性神经损伤1例（0.8%），喉头水肿2例（1.7%），远端斑块组2例（4.8%），包括股骨穿刺感染2例(4.8%)。两组均无严重并发症发生。单因素分析显示斑块位置是成功再通的显著危险因素(P=0.018),多因素分析表明，斑块位置仍然是血管再通成功的重要独立危险因素（P=0.017）。在再通手术后6-48个月的随访中，近端斑块组2例(2.8%)患者和远端斑块组4例(13.3%)患者发生再闭塞.总之,尽管混合手术在由近端或远端动脉粥样硬化斑块引起的ICA闭塞患者中取得了相似的结果，斑块位置可能是有症状的非急性长段ICA闭塞患者成功再通的重要危险因素。
