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：

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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

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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.
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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.
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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.	徐泽勤, 郭连瑞. 颈动脉狭窄诊疗进展. 山东大学耳鼻喉眼学报, 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.	李红普, 张雷, 朱盛兴. 颈动脉内膜剥脱术三种术式治疗颈动脉狭窄的临床效果. 临床医学研究与实践, 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.	蒋雄京, 邹玉宝. 锁骨下/颅外椎动脉狭窄的处理: 中国专家共识. 中国循环杂志, 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, 张成超, 齐立行, 等. 定向斑块切除联合药物涂层球囊治疗同侧锁骨下、椎动脉重度狭窄1例报告. 中国微创外科杂志, 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.	顾沅芮, 孙阳雪, 覃一朗, 等. 用于治疗椎动脉V1段狭窄的改良椎动脉-颈总动脉转位术. 中国胸心血管外科临床杂志, 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. 中华医学会外科学分会血管外科学组. 颈动脉狭窄诊治指南. 中国血管外科杂志(电子版), 2017, 9(3): 169-175.
6. 程慧冉. 颈动脉内膜切除术与颈动脉支架置入术治疗颈动脉狭窄的效果比较. 临床医学, 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. 顾沅芮, 孙阳雪, 田晨, 等. 锁骨下动脉-颈总动脉转位术在不能介入治疗的锁骨下动脉近端闭塞患者中的应用. 中国胸心血管外科临床杂志, 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. 徐泽勤, 郭连瑞. 颈动脉狭窄诊疗进展. 山东大学耳鼻喉眼学报, 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. 李红普, 张雷, 朱盛兴. 颈动脉内膜剥脱术三种术式治疗颈动脉狭窄的临床效果. 临床医学研究与实践, 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. 蒋雄京, 邹玉宝. 锁骨下/颅外椎动脉狭窄的处理: 中国专家共识. 中国循环杂志, 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, 张成超, 齐立行, 等. 定向斑块切除联合药物涂层球囊治疗同侧锁骨下、椎动脉重度狭窄1例报告. 中国微创外科杂志, 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. 顾沅芮, 孙阳雪, 覃一朗, 等. 用于治疗椎动脉V1段狭窄的改良椎动脉-颈总动脉转位术. 中国胸心血管外科临床杂志, 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

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