Effect Analysis Of Hybrid Surgery On Chronic Symptomatic Internal Carotid Artery Occlusion

ObjectiveIschemic stroke has the characteristics of high morbidity,high disability and lethality,and is one of the diseases that seriously endanger the health of human life.Internal carotid artery occlusion is one of the main causes of ischemic stroke,accounting for about 10%of ischemic stroke,but there is no uniform standard for the treatment of chronic symptomatic internal carotid artery occlusion,and different surgical procedures exist.Based on this limitation,CEA removes plaque and thrombosis in composite surgery,opens the extracranial occlusion segment,and then inserts the arterial sheath under direct vision,making it easier for the guide wire to control the vascular luminal cavity through the occlusion segment.The advantages of each operation method can improve the open rate of the target blood vessel.In view of this,this study explored the safety and effectiveness of combined surgery in the treatment of chronic symptomatic internal carotid artery occlusion,and initially explored the impact of the occlusion site on the outcome of surgical opening.MethodsThe clinical data of 37 patients with chronic symptomatic internal carotid artery occlusion who underwent hybrid surgery in the department of vascular surgery of the fifth affiliated hospital of Zhengzhou university from March 2017 to June 2019 were retrospectively analyzed.According to the location of the distal occlusion,the occluded segment of the internal carotid artery in group A(20 cases)started from the distal occlusion of the cervical segment and was located at and below the cavernous segment.In group B(17 cases),internal carotid artery occlusion started from distal cervical occlusion at or above the bed-process.The success rate of surgery,perioperative complications and the incidence of adverse events were recorded,and the general condition and improvement of neurological function(mRS score)of the patients were evaluated postoperatively.The patency of target vessels was assessed by imaging examination,and the patency rate and adverse events were recorded.Results1.37 patients with chronic long-segment occlusion of the internal carotid artery all received compound surgery,and 30 patients successfully opened occluded segment vessels(81.1%).The open rate of patients in group A was 19/20(95.0%).The open rate of patients in group B was 11/17(64.7%).The open rate of patients in group A was higher than that in group B(95.0%VS 64.7%),and the difference was statistically significant by Fisher's exact test(P=0.033).2.Perioperative complications:no serious complications or death occurred in all patients during the perioperative period.There were 4 cases of related complications among the successfully opened patients.In group A,1 case developed neck incision hematoma and the incision healed well.Group B:1 patient had internal carotid cavernous fistula during the operation.Two patients developed hyperperfusion syndrome after operation.One of the unopened patients developed neck incision infection.The difference of perioperative complications between the two groups was not statistically significant(P=0.584).3.Thirty open patients were followed up for 6 to 17 months(11 ±1.4 months).There were 2 cases of adverse events in group A,all of which were TIA symptoms,and no stroke,bleeding or other symptoms were observed.In group B,1 case of adverse event occurred,which was unstable angina pectoris attack.There was no statistically significant difference in the incidence of adverse events between the two groups during follow-up(P=1.000).The patency rate of target blood vessels was 27/30(90.0%)in the 12 months of follow-up after operation.One patient in group A had re-occlusion during the follow-up period,and the patency rate was 18/19(94.7%).Reocclusion occurred in 2 patients in group B during postoperative follow-up,and the patency rate was 9/11(81.8%).There was no significant difference in patency rate between the two groups(P=0.543).4.During the follow-up 6 months after the surgery,the modified Rankin scale was used to assess the neurological function of the patients.The mRS score(1.57±0.56 points)of the patients 6 months after the surgery was significantly lower than that before the surgery(2.20±0.92 points),and the neurological function of the patients was significantly improved.The difference was statistically significant before and after the surgery(t=6.238,P<0.01)Conclusion1.The treatment of chronic symptomatic internal carotid artery occlusion by hybrid surgery is safe and effective,with a high rate of opening,which can significantly improve the patients' nervous system function and improve brain perfusion.The results of short and mid-term follow-up are satisfactory,which can provide a new way of thinking for clinical practice.2.The open rate of compound surgery for patients with chronic long-segment internal carotid artery occlusion from distal to the cavernous segment and below was higher than that for patients with distal occlusion at the bed-process segment and above,but there was no difference in the medium-term patency rate.