Application Of Hybrid Surgery In Carotid Artery Revascularization

Background:Carotid revascularization is a surgical procedure for relieving carotid artery stenosis or occlusive disease.Ischemic cerebrovascular disease is a series of diseases that occur after cerebral ischemia and hypoxia due to extracranial or intracranial vascular stenosis or thrombosis.The total prevalence of stroke in the United States is about 2.6%.In China,cerebrovascular diseases become the third leading cause of death in our population.The common cause of ischemic cerebrovascular disease is extracranial carotid artery stenosis,especially the carotid atherosclerotic.Carotid stenosis can be classified into mild,moderate,severe and carotid artery occlusion depending on the degree of stenosis.For carotid artery occlusive disease,it is difficult to achieve recanalization of the vascular stenosis by simple internal carotid endarterectomy or intravascular stenting.For multi-focal ipsilateral internal carotid and proximal common carotid or innominate artery lesions,a single surgical technique has difficulty operating.Hybrid surgery technology can be a good solution to these two technical difficulties.Objective:To analysis of carotid artery blood transfusion reconstruction by hybrid surgery technology in Neurosurgery of Qilu Hospital in recent 3 years.To explore the application and clinical significance of hybrid surgery technology in the treatment of complex carotid artery occlusion and stenosis.To summarize clinical experience and explore a reasonable set of hybrid surgery procedures of cerebrovascular diseases.Methods:Retrospective analysis of clinical data of neurosurgical patients undergoing combined carotid artery stenosis and internal carotid artery occlusion with hybrid surgery technology between July 1,2014 and October 31,2017 in neurosurgeons of Qilu Hospital of Shandong University,summarize patient characteristics,analyze the cause of failure in patients with occlusion,standardize the surgical procedures,statistics of surgical outcomes and postoperative complications.Results:This study included a total of 37 patients undergoing carotid artery revascularization with hybrid surgery technology,among them,4 patients with carotid stenosis tandem lesions underwent internal carotid endarterectomy before composite surgery,followed by puncture with carotid artery stent angioplasty.All the 4 patients had successful operations,clinical symptoms improved or no further progress after surgery.33 patients with internal carotid artery occlusion were divided into 4 types based on the results of preoperative cerebral angiography and high-resolution magnetic resonance imaging.Summarize the hybrid surgery applied to each type of recanalization,and the recanalization rate and operation effect.6 patients failed of recanalization,including 1 case of type ? and 5 cases of type ?a.Among all cases,one patient had postoperative skin infections,secondary sutures,one patient had intraoperative emboli loss,and two patients had cardiac damage.All patients were reviewed for CTA approximately one week to one month after surgery to determine the blood flow of the internal carotid artery.Conclusion:(1)As an emerging technology,the hybrid surgery technology has a broad application prospect by comprehensively applying neurosurgery microsurgery techniques,interventional diagnostic techniques and neuronavigational techniques to treat complex neurosurgical diseases.(2)Patients with symptomatic internal carotid artery occlusion have indications for surgical opening.Comprehensive evaluation of the patient's condition is based on cerebral angiography,high-resolution magnetic resonance imaging,and cerebral perfusion scan to provide guidance for surgery.(3)Patients with carotid artery occlusion,distal reflux,and reflux bleeding to the cavernous sinus segment may attempt hybrid surgery to recanal the internal carotid artery occlusion and have a high probability of recanalization.(4)Patients with tandem lesions of carotid artery stenosis and multiple carotid artery stenosis have a high risk of open surgery or intravascular operations.A carotid endarterectomy followed by puncture endovascular treatment of multiple carotid artery stenosis can be performed using a hybrid surgical platform.