Efficacy Of Hybrid Surgery For Chronic Symptomatic Occlusion Of The Internal Carotid Artery

Objective:Chronic internal carotid artery occlusion(CICAO)has different clinical manifestations depending on the perfusion compensation.Currently,there are antiplatelet drugs,carotid endarterectomy,endovascular intervention and other ways to treat symptomatic CICAO.For patients with carotid artery occlusion,the effect of medical treatment is not good,and it is more difficult to perform a single surgical treatment.Meanwhile,the risks and benefits of opening chronic carotid artery with occlusion are still controversial.In this study,we analyzed the clinical data of 21 patients who underwent hybrid surgery(carotid artery endarterectomy combined with carotid artery stent implantation or carotid endarterectomy combined with Fogarty catheter embolectomy)to preliminarily explore the safety and efficacy of hybrid surgery for the treatment of chronic carotid artery occlusion.MethodsThe clinical and follow-up data of 46 patients with internal carotid artery occlusion who were admitted to the vascular surgery department of the Fifth Affiliated Hospital of Zhengzhou University from February 2016 to June 2019 were collected and analyzed retrospectively.According to the different treatment methods,they were divided into two groups: the hybrid operation group(n = 21),including 17 males,with an average age of(58.5 ± 5.62)years;and the drug treatment group(n =25),including 19 males,with an average age of(56.6 ± 6.25)years.At the end of the third month after treatment,the patients in hybrid operation group were treated with head and neck combined with CTA to follow up the recanalization of internal carotid artery.The recanalization of occluded internal carotid artery was evaluated by thrombolysis in cerebral infarction(tici)classification.The recanalization of occluded internal carotid artery was divided into 0 grade no recanalization,1 grade slight recanalization,2 grade partial recanalization and 3 grade complete recanalization.The data were analyzed by SPSS 25.0 statistical software.The primary end points were recanalization degree(tici grade)and modified Rankin score(MRS)at 3 months after operation.The secondary endpoint was perioperative complications.ResultsThe average time from symptom onset to revascularization was 30.5 ± 5.0 days(range,10-78 days).The success rate of revascularization was 100%.The thrombus length was 4-7 cm(5.2 ± 0.8).The grade thrombolysis rate(tici)of cerebral infarction was significantly higher than that of grade 0(P < 0.0001).The perioperative complications included recurrent laryngeal nerve injury in 1 case,intracranial hemorrhage in 1 case,but no serious neurological deficit,2 cases of cervical incision hematoma.The improved Rankin score was(2.4 ± 0.5)at 3 months after operation,which was significantly improved compared with that before revascularization(3.2 ±0.5)(P < 0.0001).At the end of the third month after operation,all patients underwent head and neck combined CTA,and the results showed that the internal carotid artery of all patients in the hybrid operation group was unobstructed.The Mrs score of the simple medication group was 3.4 ± 0.6 at admission and 3.3 ± 0.4 at 3 months.There was no significant difference between the two groups(P>0.05)conclusionHybrid surgery is a safe and effective treatment strategy for chronic symptomatic carotid artery occlusion with more satisfactory short-term follow-up than medical treatment.