Abstract: Objective To evaluate the efficacy of recanalization of chronic long segment occlusion in internal carotid artery (ICA) according to the morphology of occlusion stump. Methods The data of consecutive patients with chronic long segment ICA occlusion who underwent revascularization in Department of Cerebrovascular Disease of Henan Provincial People's Hospital from March 2015 to October 2018 were retrospectively analyzed. The included patients were divided into two groups according to occlusion stump condition on preoperative DSA: the stump group (obvious conical stump) and no-stump group (no stump, linear stump, shallow and blunt stump). The technical success rate (DSA imaging immediately after the procedure), perioperative complications, follow-up imaging results (re-occlusion rate) of the two groups were compared. Results A total of 48 patients were included, including 22 patients in the stump group and 26 patients in no-stump group. The overall technical success rate was 85.4% (41/48), and 72.7% (16/22) in the stump group, lower than 96.2% (25/26) in no-stump group (P =0.022). The overall

complication rate was 8.3% (4/48), with 13.6% (3/22) in the stump group and 3.8% (1/26) in no-

stump group (P =0.221). Hybrid operation (carotid endarterectomy and intravascular intervention) was performed in 25 cases: the initial lumen in ICA occlusion were mainly thrombi in 11 cases in the stump group, and mainly plaque in 13 cases (92.9%) of 14 cases in no-stump group. All the 41 patients with successful recanalization were followed up by color Doppler ultrasound, CTA or DSA, and the median follow-up time was 6 (4-10) months, re-occlusion occurred in 5 patients (5/41, 12.2%), and the re-occlusion rate in the stump group was higher than that in no-stump group [25.0% (4/16) vs 4.0% (1/25), P =0.045]. Conclusions The initial lumen in ICA occlusion with obvious conical stump may be mainly thrombi, while the lumen in ICA occlusion with no stump, linear stump, shallow and blunt stump may be mainly plaque. The former had low recanalization rate, high surgical risk and re-occlusion rate.

Key words: Carotid artery occlusion; Occlusion stump; Thrombus; Plaque; Endovascular treatment; Hybrid operation

摘要： 目的 根据颈内动脉残端形态预估慢性颈内动脉长节段闭塞原位开通的效果。 方法 回顾河南省人民医院脑血管病科2015年3月-2018年10月完成的连续慢性颈内动脉长节段闭 塞原位开通患者的病历资料，统计一般资料、术前术中影像资料、随访资料，根据术前DSA颈内动脉 闭塞近端残端形态将患者分为有残端组（有明显锥形残端）、无残端组（无残端、线样残端、浅钝残 端），比较两组的开通技术成功率（颈内动脉正向血流恢复）、围手术期并发症（所有神经系统并发 症和严重的非神经系统并发症）发生率、影像随访结果（再闭塞率）。 结果 共纳入48例患者，其中有残端组22例、无残端组26例。总体开通技术成功率为85.4%（41/48）， 有残端组为72.7%（16/22），低于无残端组的96.2%（25/26）（P =0.022）；总体并发症发生率为8.3% （4/48），有残端组为13.6%（3/22），无残端组为3.8%（1/26），两组差异无统计学意义（P =0.221）。共 25例采取复合手术（颈动脉内膜切除术+血管内介入治疗）的方式开通，其中，有残端组11例，颈动 脉切开后所有病例管腔内以血栓为主；无残端组14例，颈动脉切开后13例（92.9%）管腔内以斑块为 主。再通成功的41例患者均进行了彩超、CTA或DSA复查，中位随访时间6（4～10）个月，再闭塞5例（5/41， 12.2%），有残端组再闭塞率[25.0%（4/16）]明显高于无残端组[4.0%（1/25）]（P =0.045）。 结论 有明显锥形残端者颈内动脉闭塞起始段管腔内可能是以血栓为主，无残端、线样残端、浅 钝残端的病例管腔内可能是以斑块为主，前者开通成功率低、预期手术风险及再闭塞率相对较高。

关键词: 颈动脉闭塞; 闭塞残端; 血栓; 斑块; 血管内治疗; 复合手术