颅外段颈部动脉粥样硬化性疾病外科治疗京津冀专家共识

doi:10.11958/20231157

摘要/Abstract

摘要：

颅外段颈部动脉粥样硬化性疾病是最常见的脑血管病类型，外科治疗是降低患者致残率和死亡率的重要手段。天津市医学会神经外科学分会牵头组织京津冀专家结合近年来我国的临床实践和国内外相关的循证医学证据，制订了该共识。该共识对颅外段颈部动脉粥样硬化性疾病危险人群的筛查、危险因素控制、外科治疗方案以及围手术期管理等进行了总结，旨在为我国颈部动脉粥样硬化性疾病的临床治疗提供循证的规范性指导。

关键词: 动脉粥样硬化, 颈动脉狭窄, 椎底动脉供血不足, 锁骨下动脉窃血综合征

Abstract:

Extracranial segmental carotid atherosclerotic disease is the most common type of cerebrovascular disease, and surgical treatment is an important means to reduce disability and mortality of patients. The Neurosurgery Branch of Tianjin Medical Association led the organization of Beijing-Tianjin-Hebei experts to develop this consensus by combining the clinical practice in China in recent years and relevant evidence-based medical evidence at home and abroad. The consensus summarizes the screening of the risk group of extracranial segmental carotid atherosclerotic disease, risk factor control, surgical treatment options, and perioperative management, aiming to provide evidence-based normative guidance for the clinical treatment of carotid atherosclerotic disease in China.

Key words: atherosclerosis, carotid stenosis, vertebrobasilar insufficiency, subclavian steal syndrome

中图分类号:

R651.1+2

图/表 1

参考文献 22

[1]	DEL SETTE M, ELIASZIW M, STREIFLER J Y, et al. Internal borderzone infarction:a marker for severe stenosis in patients with symptomatic internal carotid artery disease. For the North American Symptomatic Carotid Endarterectomy (NASCET) Group[J]. Stroke, 2000, 31(3):631-636. doi:10.1161/01.str.31.3.631.
[2]	LEPOR N E, SUN J, CANTON G, et al. Regression in carotid plaque lipid content and neovasculature with PCSK9 inhibition:A time course study[J]. Atherosclerosis, 2021, 327:31-38. doi:10.1016/j.atherosclerosis.2021.05.008.
[3]	DEO S V, MCALLISTER D, LAFOREST S, et al. Disparities in PCSK9 initiation among US Veterans with peripheral arterial disease or cerebrovascular disease[J]. Am J Cardiovasc Drugs, 2023, 23(3):311-321. doi:10.1007/s40256-023-00576-7.
[4]	HARA T, RAI Y. Carotid Endarterectomy[J]. Adv Tech Stand Neurosurg, 2022, 44:187-207. doi:10.1007/978-3-030-87649-4_10.
[5]	XIN W, YANG S, LI Q, et al. Endarterectomy versus stenting for the prevention of periprocedural stroke or death in patients with symptomatic or asymptomatic carotid stenosis:a meta-analysis of 10 randomized trials[J]. Ann Transl Med, 2021, 9(3):256. doi:10.21037/atm-20-4620.
[6]	徐进旺, 刘希光, 李爱民, 等. 荧光造影辅助下颈动脉内膜斑块剥脱术治疗颈动脉狭窄的临床疗效[J]. 中国临床神经外科杂志, 2021, 26(2):121-123.
	XU J W, LIU X G, LI A M, et al. Clinical efficacy of fluorescence-assisted lower carotid endartery plaque peeling in the treatment of carotid artery stenosis.[J]. Chinese Journal of Clinical Neurosurgery, 2021, 26(2):121-123. doi:10.13798/j.issn.1009-153X.2021.02.019.
[7]	罗如韬, 于功义, 张东, 等. 一侧颈内动脉闭塞患者内膜剥脱术中不使用转流管的安全性分析[J]. 中华医学杂志, 2017, 97(33):2587-2590.
	LUO R T, YU G Y, ZHANG D, et al. Safety analysis of patients with internal carotid artery occlusion without a diversion tube during endometrial peeling.[J]. Chinese Medical Journal, 2017, 97(33):2587-2590. doi:10.3760/cma.j.issn.0376-2491.2017.33.007.
[8]	SALEEM T, BARIL D T. Carotid Artery Stenting[M]. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Donald Baril declares no relevant financial relationships with ineligible companies. 2023.
[9]	JENKINS J S, PATEL S N, WHITE C J, et al. Endovascular stenting for vertebral artery stenosis[J]. J Am Coll Cardiol, 2010, 55(6):538-542. doi:10.1016/j.jacc.2009.08.069.
[10]	YAMAGUCHI K, FUNATSU T, MOTEKI Y, et al. Subclavian artery-carotid artery bypass for subclavian artery or common carotid artery severe stenosis or occlusion[J]. Neurol Med Chir(Tokyo), 2023, 63(6):221-227. doi:10.2176/jns-nmc.2022-0307.
[11]	SUN T, HE Y, WANG F, et al. Hybrid surgery versus endovascular intervention for patients with chronic internal carotid artery occlusion:A single-center retrospective study[J]. Front Surg, 2022, 9:976318. doi:10.3389/fsurg.2022.976318.
[12]	彭超, 赵岩, 候长凯, 等. 使用复合手术室行颈动脉内膜剥脱术联合血管内治疗对节段性动脉粥样硬化性颈内动脉闭塞患者的疗效[J]. 中华医学杂志, 2022, 102(19):1464-1467.
	PENG C, ZHAO Y, HOU C K, et al. Efficacy and safety of carotid endarterectomy combined with endovascular therapy in hybrid operating room for patients with segmental atherosclerotic internal carotid artery occlusion[J]. Natl Med J China, 2022, 102(19):1464-1467. doi:10.3760/cma.j.cn112137-20210828-01955.
[13]	KOMATANI H, OKAMOTO Y, AOKI T, et al. Long-term prognosis after extracranial-intracranial bypass surgery for symptomatic cerebrovascular occlusive disease[J]. Kurume Med J, 2018, 64(1/2):1-4. doi:10.2739/kurumemedj.MS6400016.
[14]	YANG B, MA Y, LU X, et al. Hybrid recanalization for symptomatic long-segmental occlusion post vertebral artery stenting[J]. World Neurosurg, 2018, 110:349-353. doi:10.1016/j.wneu.2017.11.081.
[15]	MATANO F, TAMAKI T, YAMAZAKI M, et al. Vertebral artery V3 portion-radial artery-distal common carotid artery (V3-RA-dCCA) bypass for large basilar trunk aneurysm with bilateral proximal common carotid artery occlusion-technical note[J]. Acta Neurochir (Wien), 2022, 164(4):1031-1035. doi:10.1007/s00701-021-04930-z.
[16]	崔小鹏, 赵岩, 汪邦月, 等. 颈总动脉-锁骨下动脉搭桥术治疗症状性锁骨下动脉闭塞的临床疗效[J]. 中华神经外科杂志, 2021, 37(11):1136-1140.
	CUI X P, ZHAO Y, WANG B Y, et al. Clinical efficacy of common carotid-subclavian artery bypass grafting in the treatment of symptomatic subclavian artery occlusion[J]. Chinese Journal of Neurosurgery, 2021, 37(11):1136-1140. doi:10.3760/cma.j.cn112050-20210221-00092.
[17]	PENG C, YANG Y F, ZHAO Y, et al. Staged versus synchronous carotid endarterectomy and coronary artery bypass grafting:a Meta-analysis and systematic review[J]. Ann Vasc Surg, 2022, 86:428-439. doi:10.1016/j.avsg.2022.05.027.
[18]	康晓魁, 杨新宇, 张建宁, 等. 颈动脉和冠状动脉联合病变的处理策略[J]. 中华神经外科杂志, 2013, 29(2):207-210.
	KANG X K, YANG X Y, ZHANG J N, et al. Management strategy of carotid artery and coronary artery joint lesions[J]. Chinese Journal of Neurosurgery, 2013, 29(2):207-210.doi:10.3760/cma.j.issn.1001-2346.2013.02.032.
[19]	李洪利, 焦力群, 王亚冰, 等. 冠状动脉合并颈动脉粥样硬化性狭窄患者同期血运重建七例临床分析[J]. 中国脑血管病杂志, 2021, 18(6):405-412.
	LI H L, JIAO L Q, WANG Y B, et al. Clinical analysis of seven patients with coronary artery combined with carotid atherosclerotic stenosis in patients with concurrent revascularization[J]. Chinese Journal of Cerebrovascular Diseases, 2021, 18(6):405-412. doi:10.3969/j.issn.1672-5921.2021.06.006.
[20]	杨阳, 王涛. 颈动脉重度狭窄合并冠状动脉狭窄的外科治疗现状[J]. 临床神经外科杂志, 2018, 15(5):398-400.
	YANG Y, WANG T. Current status of surgical treatment of severe carotid artery stenosis combined with coronary artery stenosis[J]. Journal of Clinical Neurosurgery, 2018, 15(5):398-400. doi:10.3969/j.issn.1672-7770.2018.05.020.
[21]	张振, 杨新宇, 李廼昕, 等冠脉搭桥合并严重颈动脉狭窄二例[J]. 中华神经外科杂志, 2014, 30(2):214-215.
	ZHANG Z, YANG X Y, LI N X, et al. Two cases of coronary artery bypass grafting combined with severe carotid artery stenosis[J]. Chinese Journal of Neurosurgery, 2014, 30(2):214-215. doi:10.3760/cma.j.issn.1001-2346.2014.02.035.
[22]	TAYLOR C, WALSH E, STAMM S. Synchronous CEA and CABG in asymptomatic carotid artery stenosis:A case study[J]. J Vasc Nurs, 2019, 37(3):194-198. doi:10.1016/j.jvn.2019.03.002.