Carotid endarterectomy combined with vertebral artery transposition treating vertebral artery V1 segment stenosis combined with ipsilateral carotid artery stenosis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GU Yuanrui ¹ , ZHOU Zeming ¹ , SUN Yangxue ¹ , QIN Yilang ¹ , TIAN Chen ¹ , REN Jingjing ² , TIAN Chuan ¹ , FANG Kun ¹ , OUYANG Wenbin ¹ , ZHANG Ying ¹ , LUO Mingyao ¹ , SHU Chang ¹ ,  OUYANG Chenxi ¹

1. Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;
2. Department of Party and Government Office, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding?author：

OUYANG Chenxi, Email: ouyangchx@nccd.org.cn

Keywords：

Carotid artery stenosis; vertebral artery stenosis; carotid endarterectomy; vertebral artery transposition

DOI：

10.7507/1007-4848.202104004

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the treatment outcome of carotid endarterectomy combined with vertebral artery transposition in patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery.Methods From June 2017 to September 2020, patients with severe stenosis to occlusion of the vertebral artery V1 segment and the ipsilateral carotid artery treated with carotid endarterectomy combined with vertebral artery transposition in Fuwai Hospital were retrospectively analyzed.Results Finally 12 patients were enrolled, including 10 males and 2 females with an average age of 67.8±6.0 years. Twelve patients were successfully operated and the follow-up time was 1-3 years. The stenosis degree of the V1 segment of the vertebral artery decreased from 83.5%±11.8% to 24.9%±14.3% (P＜0.001). The stenosis degree of carotid artery decreased from 85.6%±11.0% to 0% (P＜0.001). Postoperative follow-up showed that the symptoms of symptomatic patients before surgery improved. The 1-year and 3-year patency rates were 100.0%, and there were no peripheral nerve injury complications, perioperative deaths or strokes.Conclusion Carotid endarterectomy combined with vertebral artery transposition can treat ipsilateral carotid artery stenosis and vertebral artery stenosis at the same time, improve blood supply to the brain, improve patients' symptoms and has high promotion value.

Citation： GU Yuanrui, ZHOU Zeming, SUN Yangxue, QIN Yilang, TIAN Chen, REN Jingjing, TIAN Chuan, FANG Kun, OUYANG Wenbin, ZHANG Ying, LUO Mingyao, SHU Chang, OUYANG Chenxi. Carotid endarterectomy combined with vertebral artery transposition treating vertebral artery V1 segment stenosis combined with ipsilateral carotid artery stenosis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(5): 704-709. doi: 10.7507/1007-4848.202104004 Copy

1.	GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet, 2017, 390(10100): 1151-1210.
2.	Zhou M, Wang H, Zhu J, et al. Cause-specific mortality for 240 causes in China during 1990-2013: A systematic subnational analysis for the Global Burden of Disease Study 2013. Lancet, 2016, 387(10015): 251-272.
3.	Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010. Lancet, 2014, 383(9913): 245-254.
4.	Wu S, Wu B, Liu M, et al. Stroke in China: Advances and challenges in epidemiology, prevention, and management. Lancet Neurol, 2019, 18(4): 394-405.
5.	中華醫學會外科學分會血管外科學組. 頸動脈狹窄診治指南. 中國血管外科雜志(電子版), 2017, 9(3): 169-175.
6.	程慧冉. 頸動脈內膜切除術與頸動脈支架置入術治療頸動脈狹窄的效果比較. 臨床醫學, 2020, 40(11): 71-73.
7.	Che WQ, Dong H, Jiang XJ, et al. Clinical outcomes and influencing factors of in-stent restenosis after stenting for symptomatic stenosis of the vertebral V1 segment. J Vasc Surg, 2018, 68(5): 1406-1413.
8.	Wityk RJ, Chang HM, Rosengart A, et al. Proximal extracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry. Arch Neurol, 1998, 55(4): 470-478.
9.	Savardekar AR, Narayan V, Patra DP, et al. Timing of carotid endarterectomy for symptomatic carotid stenosis: A snapshot of current trends and systematic review of literature on changing paradigm towards early surgery. Neurosurgery, 2019, 85(2): E214-E225.
10.	顧沅芮, 孫陽雪, 田晨, 等. 鎖骨下動脈-頸總動脈轉位術在不能介入治療的鎖骨下動脈近端閉塞患者中的應用. 中國胸心血管外科臨床雜志, 2020, 27(9): 1005-1009.
11.	Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries endorsed by: The European Stroke Organization (ESO) Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J, 2018, 39(9): 763-816.
12.	Compter A, van der Worp HB, Algra A, et al. Prevalence and prognosis of asymptomatic vertebral artery origin stenosis in patients with clinically manifest arterial disease. Stroke, 2011, 42(10): 2795-2800.
13.	Antoniou GA, Murray D, Georgiadis GS, et al. Percutaneous transluminal angioplasty and stenting in patients with proximal vertebral artery stenosis. J Vasc Surg, 2012, 55(4): 1167-1177.
14.	Parkhutik V, Lago A, Tembl JI, et al. Angioplasty and stenting of symptomatic and asymptomatic vertebral artery stenosis: To treat or not to treat. Eur J Neurol, 2010, 17(2): 267-272.
15.	徐澤勤, 郭連瑞. 頸動脈狹窄診療進展. 山東大學耳鼻喉眼學報, 2020, 34(4): 11-15.
16.	AbuRahma AF, Mousa AY. Current status of carotid stenting versus endarterectomy. Adv Surg, 2016, 50(1): 235-256.
17.	李紅普, 張雷, 朱盛興. 頸動脈內膜剝脫術三種術式治療頸動脈狹窄的臨床效果. 臨床醫學研究與實踐, 2019, 4(24): 61-63.
18.	Hass WK, Fields WS, North RR, et al. Joint study of extracranial arterial occlusion.Ⅱ. Arteriography, techniques, sites, and complications. JAMA, 1968, 203(11): 961-968.
19.	蔣雄京, 鄒玉寶. 鎖骨下/顱外椎動脈狹窄的處理: 中國專家共識. 中國循環雜志, 2019, 34(6): 523-532.
20.	Stayman AN, Nogueira RG, Gupta R. A systematic review of stenting and angioplasty of symptomatic extracranial vertebral artery stenosis. Stroke, 2011, 42(8): 2212-2216.
21.	Roon AJ, Ehrenfeld WK, Cooke PB, et al. Vertebral artery reconstruction. Am J Surg, 1979, 138(1): 29-36.
22.	谷涌泉, 張成超, 齊立行, 等. 定向斑塊切除聯合藥物涂層球囊治療同側鎖骨下、椎動脈重度狹窄1例報告. 中國微創外科雜志, 2019, 19(5): 473-475.
23.	Kieffer E, Praquin B, Chiche L, et al. Distal vertebral artery reconstruction: Long-term outcome. J Vasc Surg, 2002, 36(3): 549-554.
24.	顧沅芮, 孫陽雪, 覃一朗, 等. 用于治療椎動脈V1段狹窄的改良椎動脈-頸總動脈轉位術. 中國胸心血管外科臨床雜志, 2022, 29(3): 366-370.

1. GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet, 2017, 390(10100): 1151-1210.
2. Zhou M, Wang H, Zhu J, et al. Cause-specific mortality for 240 causes in China during 1990-2013: A systematic subnational analysis for the Global Burden of Disease Study 2013. Lancet, 2016, 387(10015): 251-272.
3. Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010. Lancet, 2014, 383(9913): 245-254.
4. Wu S, Wu B, Liu M, et al. Stroke in China: Advances and challenges in epidemiology, prevention, and management. Lancet Neurol, 2019, 18(4): 394-405.
5. 中華醫學會外科學分會血管外科學組. 頸動脈狹窄診治指南. 中國血管外科雜志(電子版), 2017, 9(3): 169-175.
6. 程慧冉. 頸動脈內膜切除術與頸動脈支架置入術治療頸動脈狹窄的效果比較. 臨床醫學, 2020, 40(11): 71-73.
7. Che WQ, Dong H, Jiang XJ, et al. Clinical outcomes and influencing factors of in-stent restenosis after stenting for symptomatic stenosis of the vertebral V1 segment. J Vasc Surg, 2018, 68(5): 1406-1413.
8. Wityk RJ, Chang HM, Rosengart A, et al. Proximal extracranial vertebral artery disease in the New England Medical Center Posterior Circulation Registry. Arch Neurol, 1998, 55(4): 470-478.
9. Savardekar AR, Narayan V, Patra DP, et al. Timing of carotid endarterectomy for symptomatic carotid stenosis: A snapshot of current trends and systematic review of literature on changing paradigm towards early surgery. Neurosurgery, 2019, 85(2): E214-E225.
10. 顧沅芮, 孫陽雪, 田晨, 等. 鎖骨下動脈-頸總動脈轉位術在不能介入治療的鎖骨下動脈近端閉塞患者中的應用. 中國胸心血管外科臨床雜志, 2020, 27(9): 1005-1009.
11. Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries endorsed by: The European Stroke Organization (ESO) Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J, 2018, 39(9): 763-816.
12. Compter A, van der Worp HB, Algra A, et al. Prevalence and prognosis of asymptomatic vertebral artery origin stenosis in patients with clinically manifest arterial disease. Stroke, 2011, 42(10): 2795-2800.
13. Antoniou GA, Murray D, Georgiadis GS, et al. Percutaneous transluminal angioplasty and stenting in patients with proximal vertebral artery stenosis. J Vasc Surg, 2012, 55(4): 1167-1177.
14. Parkhutik V, Lago A, Tembl JI, et al. Angioplasty and stenting of symptomatic and asymptomatic vertebral artery stenosis: To treat or not to treat. Eur J Neurol, 2010, 17(2): 267-272.
15. 徐澤勤, 郭連瑞. 頸動脈狹窄診療進展. 山東大學耳鼻喉眼學報, 2020, 34(4): 11-15.
16. AbuRahma AF, Mousa AY. Current status of carotid stenting versus endarterectomy. Adv Surg, 2016, 50(1): 235-256.
17. 李紅普, 張雷, 朱盛興. 頸動脈內膜剝脫術三種術式治療頸動脈狹窄的臨床效果. 臨床醫學研究與實踐, 2019, 4(24): 61-63.
18. Hass WK, Fields WS, North RR, et al. Joint study of extracranial arterial occlusion.Ⅱ. Arteriography, techniques, sites, and complications. JAMA, 1968, 203(11): 961-968.
19. 蔣雄京, 鄒玉寶. 鎖骨下/顱外椎動脈狹窄的處理: 中國專家共識. 中國循環雜志, 2019, 34(6): 523-532.
20. Stayman AN, Nogueira RG, Gupta R. A systematic review of stenting and angioplasty of symptomatic extracranial vertebral artery stenosis. Stroke, 2011, 42(8): 2212-2216.
21. Roon AJ, Ehrenfeld WK, Cooke PB, et al. Vertebral artery reconstruction. Am J Surg, 1979, 138(1): 29-36.
22. 谷涌泉, 張成超, 齊立行, 等. 定向斑塊切除聯合藥物涂層球囊治療同側鎖骨下、椎動脈重度狹窄1例報告. 中國微創外科雜志, 2019, 19(5): 473-475.
23. Kieffer E, Praquin B, Chiche L, et al. Distal vertebral artery reconstruction: Long-term outcome. J Vasc Surg, 2002, 36(3): 549-554.
24. 顧沅芮, 孫陽雪, 覃一朗, 等. 用于治療椎動脈V1段狹窄的改良椎動脈-頸總動脈轉位術. 中國胸心血管外科臨床雜志, 2022, 29(3): 366-370.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Carotid endarterectomy combined with vertebral artery transposition treating vertebral artery V1 segment stenosis combined with ipsilateral carotid artery stenosis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content