背景:为复发性颈动脉狭窄患者选择最佳治疗方式取决于许多变量,包括复发斑块形态的病因和复发病灶的位置。干预措施最重要的考虑因素是安全性,修复的短期和长期耐久性,以及手术团队的技能和经验。我们回顾了我们关于原发性和重做颈动脉内膜切除术(CEA)数据的手术系列结果,以评估手术干预的短期和长期结果。我们还评估了斑块病变特征与复发性狭窄发展之间的关系。
方法:回顾性回顾了由一名血管外科医生进行的所有接受CEA和重做CEA(RCEA)的患者的图表,为期10年。术前数据包括患者的人口统计学和主要CEA和RCEA之间的间隔,被记录和总结。外科手术,location,同时记录颈动脉病变(原发性或复发性)的形态学特征.手术结果,包括局部并发症,全身性并发症,逗留时间,再狭窄率,短期和长期的中风率,被审查了。
结果:从1997年到2007年,一名血管外科医生对总共1198名患者进行了1324次连续的CEA手术。对212例患者进行了需要RCEA的再狭窄,其中包括192个第一RCEA和27个第二RCEA。所有接受原发性CEA的患者均为高级作者的原始患者。对我们的7名原始患者进行了RCEA,其余RCEA病例为转诊患者。从主要CEA到第一次RCEA的间隔从2个月到29年,平均4.4年。在这组患者中,男性/女性比例为45%/55%,平均年龄为61岁(范围38~74岁).百分之八十三(192个中的159个)使用烟草,与原发性CEA组的54%相比。此外,在这组患者中,192例患者中有25例(13%)发生颅神经损伤。这些伤害大部分是暂时的,但4例患者有长期损伤,1例患者有永久性损伤。发生1例非致死性心肌梗死(MI)。没有中风或死亡的事件。平均2.1年,3例患者(1.5%)发生了明显的再狭窄。这些统计数据与我们的主要CEA系列中的发现相比,其中颅神经损伤为4%(1105个中的44个),术后心肌梗塞为0.5%(1105人中的6人),中风率为0.18%(1105年中的2例),死亡率为0%,在平均4.4年的时间内,0.36%(1105中的4例)的患者发生了显着的再狭窄。
结论:在我们的回顾性研究中,RCEA后的卒中和再狭窄率与原发性CEA后相似.因此,我们认为RCEA对于在原发性CEA后复发的颈动脉疾病患者是一种可行的治疗选择.
BACKGROUND: Choosing the optimal treatment modality for patients with recurrent carotid artery stenosis depends upon many variables, including the etiology of the recurrent plaque morphology and the location of the recurrent lesion. The most important considerations for interventions are the safety, short- and long-term durability of the repair, and the surgical team\'s skills and experience. We reviewed the results of our operative series on primary and redo carotid endarterectomy (CEA) data to evaluate the short- and long-term outcomes of surgical intervention. We also evaluated the relationship between plaque lesion characteristics with respect to the development of recurrent stenosis.
METHODS: The charts of all patients who underwent CEAs and redo CEAs (RCEAs) performed by one vascular surgeon were retrospectively reviewed for a 10-year period. Preoperative data, including patients\' demographics and interval between the primary CEAs and RCEAs, were recorded and summarized. The surgical procedure, location, and morphologic characteristics of the carotid lesions (primary or recurrent) were also recorded. Surgical outcomes, including local complications, systemic complications, length of stay, restenosis rate, and short-and long-term stroke rates, were reviewed.
RESULTS: From 1997 to 2007, one vascular surgeon performed 1324 consecutive CEA procedures on a total of 1198 patients. Restenosis that required RCEA was performed on 212 patients, which included 192 first RCEAs and 27 second RCEAs. All patients who underwent primary CEAs were original patients of the senior author. RCEAs were performed on 7 of our original patients, and the remaining RCEA cases were referred patients. The interval from primary CEA to first RCEA ranged from 2 months to 29 years, with an average of 4.4 years. In this group of patients, the male/female ratio was 45%/55% and average age was 61 years (range 38-74 years). Eighty-three percent (159 of 192) used tobacco, compared with 54% in the primary CEA group. Also, in this group of patients, cranial nerve injuries occurred in 25 of the 192 patients (13%). The majority of these injuries were temporary, but 4 patients had prolonged injury and 1 patient had a permanent injury. One nonfatal myocardial infarction (MI) occurred. There were no incidents of stroke or death. Significant restenosis occurred in 3 patients (1.5%) over an average of 2.1 years. These statistics compare favorably with finding from our series of primary CEAs, in which cranial nerve injury was 4% (44 of 1105), postoperative myocardial infarction was 0.5% (6 of 1105), stroke rate was 0.18% (2 of 1105), and death rate was 0%, with significant restenosis occurring in 0.36% (4 of 1105) of patients over an average of 4.4 years.
CONCLUSIONS: In our retrospective study, the stroke and restenosis rates after RCEAs were similar to those after primary CEA. Therefore, we consider RCEA to be a viable therapeutic option in patients with carotid disease that recurs after a primary CEA.