评价颈动脉内膜切除补片成形术治疗支架内再狭窄（ISR）的可行性、安全性和长期疗效。

回顾分析2018年10月至2022年3月中国医科大学附属第一医院神经外科收治的采用颈动脉内膜切除补片成形术治疗ISR患者8例。男性7例，女性1例，年龄为64.0（56.0，69.0）岁（范围为52~73岁）。颈动脉内膜切除补片成形术距离颈动脉支架植入术（CAS）的时间间隔为11.5（4.0，18.5）个月（范围4 d~124个月）。其中间隔4 d的病例为CAS术中保护伞滞留在支架内。均经脑血管造影确诊，行颈动脉内膜切除补片成形术治疗。其中1例患者外院颈动脉内膜切除补片成形术治疗ISR后22个月，出现症状性中度再狭窄，本院行颈动脉补片成形术。术后1、3、6、12个月及之后每年随访颈动脉超声或计算机断层扫描血管造影。

所有患者均成功行颈动脉内膜切除补片成形术，6例患者取出支架和动脉硬化斑块，1例患者取出2枚支架、1个保护伞和动脉硬化斑块。7例（87.5%）患者术中监测经颅超声多普勒，5例（62.5%）使用颈动脉转流管。手术成功率为100%。术后无颅内出血和新发脑梗死，未出现心肌缺血及脑组织过度灌注。出现舌下神经和迷走神经损伤各1例，3个月随访时完全恢复。1例手术当日出现对侧上肢一过性无力发作。术后随访时间为29.5（17.5，42.0）个月（范围7~47个月）。随访期间未发生颈动脉中重度再狭窄，所有患者恢复正常生活。

颈动脉内膜切除补片成形术可以安全有效地治疗ISR，术后长期疗效满意。

To evaluate the feasibility, safety and long-term efficacy of carotid endarterectomy with patch angioplasty in the treatment of in-stent restenosis (ISR).

The clinical data of 8 cases with ISR treated with carotid endarterectomy with patch angioplasty from October 2018 to March 2022 in the department of Neurosurgery of the first affiliated hospital of China Medical University were retrospectively analyzed. They were 52-73 years old, with a median age of 64.0 (IQR 56.0, 69.0) years. The interval between carotid endarterectomy with patch angioplasty and carotid artery stenting (CAS) ranged from 4 days to 124 months, with a median interval of 11.5 (IQR 4.0, 18.5) months. Among them, the case with an interval of 4 days was surgical retrieval of a filter protection device in CAS with two open-cell stents. All patients were diagnosed by digital subtraction angiography and treated with carotid endarterectomy with patch angioplasty. One of the patients presented with symptomatic moderate restenosis 22 months after ISR was treated by carotid endarterectomy with patch angioplasty in another hospital, and carotid artery patch angioplasty was performed in our hospital. Carotid ultrasound or computed tomography angiography was followed up at 1, 3, 6, 12 months and every year postoperatively.

All patients underwent carotid artery patch angioplasty successfully. Stents and atherosclerotic plaque were removed in 6 patients. Two stents and one filter protection device and atherosclerotic plaque were removed in another patient. Transcranial ultrasound doppler was applied in 7 patients (87.5%)，and carotid shunt tubes were used in 5 patients (62.5%). The success rate of surgical technique is 100%. No intracranial hemorrhage, new-onset cerebral infarction, myocardial ischemia, and cerebral tissue hyperperfusion occurred after the operation. There was one case of hypoglossal nerve injury and one of vagus nerve injury, who both recovered completely at 3-month follow-up. On the day of the operation, one patient had a transient attack of contralateral upper limb weakness. Postoperative follow-up was 7-47 months, with a median follow-up time of 29.5 (IQR 17.5, 42.0) months. No moderate or severe carotid artery restenosis occurred during follow-up, and all patients returned to normal life.

carotid endarterectomy with patch angioplasty can safely and effectively treat ISR and the postoperative long-term curative effect was satisfied