探讨慢性症状性颈内动脉闭塞开通的安全性、可行性及临床疗效。

回顾性分析并总结苏州市立医院神经外科2019年1月至2020年12月行血管内治疗或复合手术治疗开通闭塞血管的12例慢性症状性颈内动脉闭塞患者的临床资料。

10例患者采用血管内治疗，2例患者采用复合手术治疗，其中10例患者成功开通，2例患者开通失败。10例成功开通的患者出院前复查CT血管成像（CTA）均显示血管通畅，CT灌注成像（CTP）显示患者脑血容量、脑血流量、平均通过时间、达峰时间较术前均有一定程度的改善，但未完全恢复正常。随访过程中，成功开通的10例患者中6例患者临床症状得到了改善，4例患者临床症状较前无明显变化。2例开通失败的患者临床症状与术前相仿。再通的患者中，1例患者因自行停用双抗药物，手术后3个月复查CTA显示手术侧颈内动脉再闭塞，2例患者随访过程中复查CTA发现血管存在一定程度的再狭窄（≤50%）。开通失败患者中有1例出现医源性颈内动脉海绵窦瘘，6个月随访复查颅脑数字减影血管造影显示瘘口闭塞。

有症状的慢性颈内动脉闭塞病例在手术指征明确的前提下行血管内治疗或复合手术治疗是可行的，且安全性较高，疗效较显著。

To investigate the safety, feasibility, and clinical efficacy of recanalization of chronic symptomatic internal carotid artery occlusion.

The clinical data of 12 patients with chronic symptomatic internal carotid artery occlusion who underwent endovascular therapy or hybrid surgery from January 2019 to December 2020 in the Neurosurgery department of Suzhou Municipal Hospital were retrospectively analyzed and summarized.

Ten patients were treated with endovascular therapy, and another two patients were treated with hybrid surgery. Among them, ten patients were successfully recanalized, and the other two patients failed to recanalize. CT angiography (CTA) of the ten patients who were successfully recanalized before the discharge showed that the blood vessels were unobstructed. CT perfusion imaging（CTP）showed that the cerebral blood volume, cerebral blood flow, average transit time, and peak time of the patients were improved to some extent compared with themselves before surgery. Still, they did not completely return to normal. Among the ten patients who were successfully recanalized during the follow-up, six patients' clinical symptoms improved, and the other four patients' clinical symptoms did not change significantly. The clinical symptoms of two patients with failed patency were similar to those before the operation. Among the patients who were recanalized, one patient stopped using dual antiplatelet therapy on his own. Three months after the operation, CTA showed that the internal carotid artery on the operative side was re-occluded. During follow-up, CTA of two patients found a certain degree of restenosis (≤50%). Among the patients who failed, one patient had iatrogenic carotid cavernous fistula. Six months after follow-up, digital subtraction angiography of the brain showed that the fistula was occluded.

It is feasible to treat symptomatic patients with chronic internal carotid artery occlusion with endovascular therapy or hybrid surgery under the premise of clear surgical indications, with high safety and significant efficacy.