Clinical Outcomes of Microsurgical Flow Reconstruction in Long-Segment Cervical Internal Carotid Artery Stenosis with Distal Grade 2 or 3 Kinking
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Tarih
2025
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
ELSEVIER SCIENCE INC
Erişim Hakkı
Özet
Background: To evaluate the clinical outcomes of perivascular sympathectomy-assisted arteriolysis combined with kinking correction in patients with long-segment cervical internal carotid artery (ICA) stenosis accompanied by Grade 2 or 3 distal kinking. Methods: Nineteen patients with symptomatic, nonatherosclerotic, >= 5 cm-long tubular ICA stenosis and distal kinking (Grade 2 or 3) underwent microsurgical decompression between 2017 and 2023. Surgical intervention included circumferential arteriolysis, perivascular sympathectomy, and correction of the kinking. Clinical symptoms such as hemiparesis, dysphasia, seizures, migraine, and tinnitus were assessed preoperatively and postoperatively up to 24 months. Radiological outcomes were evaluated using computed tomography/magnetic resonance angiography and perfusion imaging. Preoperative and postoperative vessel diameters were measured intraoperatively. The analysis used SPSS and statistical significance was set at P < 0.05. Results: Significant postoperative symptom resolution was observed in hemiparesis (100%), motor dysphasia (100%), migraine (88.9%), and seizures (83.3%). Intraoperative diameter of the ICA increased by 1.5-2-fold following sympathectomy (mean preoperative diameter: 3.4 mm; postoperative: 7.5 mm; P < 0.001). Perfusion imaging demonstrated improved cerebral blood flow in the affected vascular territory in all patients. Conclusions: Microsurgical flow reconstruction using arteriolysis and perivascular sympathectomy with kinking correction is a promising technique for selected patients with complex cervical ICA stenosis not amenable to endovascular treatment. It achieves significant symptomatic relief and improves hemodynamic parameters without major complications.
Açıklama
Anahtar Kelimeler
Arteriolysis, Cervical internal carotid artery, Grade 2 or 3 kinking, Long-segment tubular stenosis, Microsurgical intervention, Perivascular sympathectomy
Kaynak
WORLD NEUROSURG
WoS Q Değeri
Scopus Q Değeri
Cilt
201
