颈动脉慢性完全闭塞后再通的症状（英文）

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1、EndovascularRecanalizationofSymptomaticChronicTotalOcclusionofCervicalCarotidArteryPaulHsien-LiKao,MDAssistantProfessorNationalTaiwanUniversityMedicalSchoolandHospitalICAstentingProventobeanalternativetoCEAinICAstenosis,especiallyinpatientswithhighsurgicalriskprofilesB

2、uttheapplicationofendovascularinterventionincervicalICAocclusion(ICAO)hasneverbeenexplored,whichcomprise15%ofpatientswithipsilateralTIAorinfarctionPaulHLKao08ThegreatmythICAstenosiscausessymptomsthroughartery-to-arteryembolismTheriskofstrokeisminimalwithICAO,becausethe

3、reisnoflowtocarrytheemboliIsittrue?PaulHLKao08PrognosisandpathophysiologyofICAOCervicalICAOisanimportantcauseofTIAandcerebralinfarctionandshouldnotbeneglectedAnnualriskofipsilateralstrokeinsymptomaticICAOis6-20%AnnualriskofipsilateralstrokeinasymptomaticICAOis2-5%Patho

4、physiologyofsymptomsEmboliarisingfromECA/CCAviacollateralsEmboliarisingfromICAstumpviacollaterals(Stumpsyndrome)EmboliarisingfromtrailingthrombidistaltotheocclusionHypo-perfusion(hemodynamicinsufficiency)PaulHLKao08TreatmentoptionsforICAOMedicalTherecommendedtreatmenta

5、tpresent,butmaybeinsufficientforcertainpatientsSurgeryCEAStumpligation/exclusionEC/ICbypassCanbeverytechnicallydemandingwithhighperiproceduralcomplicationsAllfailedtoreduceipsilateralstrokeandarenotrecommendedtoICACTOingeneralPaulHLKao08EC/ICbypass1377patientswithsympt

6、omaticICAorMCAocclusionorhigh-gradeICstenosisrandomizedtoSTA-MCAbypassormedicaltreatmentandfollowedfor56monthsMajorperi-operativestrokerateas4.5%TotalstrokerateswerenotdifferentbetweenbypassandmedicalgroupsInpatientswithongoingsymptomsafterangiographicdocumentationofIC

7、AO,thebenefitofbypasswasnotshowneitherPaulHLKao08NEJM.1985;313:1191–1200Reviewofstudies20studiesinpatientswithTIAorischemicstrokeassociatedwithICAO,theannualriskofallandipsilateralstrokewere5.5%and2.1%PatientswithacompromisedCBFmeasuredbyPET,SPECT,TcD,orXeCThaveanevenh

8、igherannualriskofallandipsilateralstroke(12.5%and9.5%)Stroke.1997;28:2084–2093PaulHLKao08Identifytherightpatienttorev