■有症状的颈总动脉(CCA)闭塞很少见,其治疗仍未建立。尽管已经报道了锁骨下至颈动脉旁路手术的病例,很少有颈动脉-颈动脉交叉旁路手术的报道,尽管它的优势。我们报告了一例主动脉弓置换术后Riles1A型症状性CCA闭塞的病例,该病例采用颈动脉-颈动脉交叉旁路术治疗,结果良好。
■一位有高血压病史的65岁女性,高脂血症,糖尿病,全弓置换胸主动脉瘤入院,主诉为右偏瘫和运动性失语。头部磁共振成像显示左脑半球有新的梗塞。颈部计算机断层扫描(CT)血管造影显示左侧CCA闭塞。胸部CT血管造影显示左锁骨下动脉严重狭窄。SPECT显示左脑半球血流量普遍减少。我们使用穿过皮下隧道的合成移植物进行了颈动脉到颈动脉的交叉旁路。首先,行右侧颈动脉合成移植物端侧吻合术.随后,我们进行了人工合成的移植物-左CCA端侧吻合术.术后病程顺利。颈部计算机断层扫描血管造影显示交叉旁路完全通畅。患者几乎完全康复,并独立进行日常活动。
■颈动脉-颈动脉交叉旁路术是一种有症状的CCA闭塞的持久治疗方法。需要进一步的研究将其结果与其他方法进行比较,并以更大的样本量证实我们的发现。
UNASSIGNED: Symptomatic common carotid artery (CCA) occlusion is rare and its treatment remains unestablished. Although cases of subclavian-to-carotid bypass have been reported, very few cases of carotid-tocarotid crossover bypass have been reported, despite its advantages. We report a
case of Riles type 1A symptomatic CCA occlusion after aortic arch replacement that was treated with carotid-to-carotid crossover bypass with favorable outcomes.
UNASSIGNED: A 65-year-old woman with a history of hypertension, hyperlipidemia, diabetes, and total arch replacement for thoracic aortic aneurysm was admitted to our hospital with a complaint of the right hemiparesis and motor aphasia. Head magnetic resonance imaging revealed a fresh infarction in the left cerebral hemisphere. Cervical computed tomography (CT) angiography revealed left CCA occlusion. Thoracic CT angiography showed severe stenosis of the left subclavian artery. SPECT showed a general decrease in blood flow in the left cerebral hemisphere. We performed a carotid-to-carotid crossover bypass with a synthetic graft that was passed through the subcutaneous tunnel. First, the right carotid artery-synthetic graft end-to-side anastomosis was performed. Subsequently, we performed synthetic graft-left CCA end-to-side anastomosis. The postoperative course was uneventful. Cervical computed tomography angiography showed perfect patency of the crossover bypass. The patient recovered almost completely and was independently performing daily activities.
UNASSIGNED: Carotid-to-carotid crossover bypass is a durable treatment for symptomatic CCA occlusion. Further studies are needed to compare its outcomes with those of other methods and to confirm our findings with larger sample size.