目的:分析复杂类型症状性颈动脉重度狭窄患者的病例特征及血管内支架治疗手术特点。方法:总结2013年1月至2019年7月36例颈动脉狭窄程度大于90%的复杂病例，其中狭窄程度95%～99%次全闭塞22例，狭窄对侧颈内动脉闭塞6例，主动脉弓及颈动脉严重扭曲高龄患者4例，狭窄远端颈内动脉成角扭曲距离过近4例。分析以上4种类型复杂病例的病变特点及数字减影血管造影(digital subtraction angiography, DSA)脑血流代偿情况，总结血管内治疗的手术技巧，注重个体化手术计划及围手术期处理、患者的耐受情况和血运重建结构的变化，控制并发症的发生，术后随访1年观察再狭窄及相关缺血性脑血管事件的发生情况。结果:次全闭塞患者全部采用近端血流保护装置行颈动脉支架成形术(carotid artery stenting，CAS)，1例手术失败，2例二期支架植入；对侧闭塞患者采用术前镇静、适当升压以及缩短阻断时间的方法完成手术；路径扭曲支撑力不足患者采用同轴多导丝多次交换长鞘辅助技术操作；狭窄远端成角患者，支架近端释放2例，跨成角释放后血流无影响1例，跨成角释放后血流受影响而放弃手术1例。手术成功34例(94.4%)，狭窄程度由术前(93.1±3.2)%降至术后(21.5±4.8)%；术中3例出现一过性失语、对侧肢体偏瘫缺血症状。随访1年无脑出血、脑梗死事件发生，无支架内再狭窄。结论:CAS治疗复杂类型颈动脉重度狭窄的患者时需注意个体化细节管理及围手术期处理，选择适合的手术方案，以确保手术的成功率和安全性。“,”Objective:To analyze the characteristics of complex severe symptomatic carotid stenosis, and to summarize the surgical techniques of endovascular stent treatment.Methods:A total of 36 cases of complex carotid stenosis with stenosis greater than 90% from January 2013 to July 2019 were selected, among which 22 patients with subtotal occlusion with stenosis of 95%~99%, 6 patients with contralateral internal carotid artery occlusion, 4 elderly patients with severe twisted aortic arch and carotid artery, and 4 patients with angular distortions of internal carotid artery that were too close at the stenosis distal end. The characteristics of pathological change and the state of cerebral blood flow compensation under digital subtraction angiography (DSA) of these 4 above-mentioned complex types were analyzed. The techniques of endovascular surgery were summarized, focusing on the individualized surgical plan, perioperative management, patients′ tolerance, revascularization structure change, complication control, and the occurrence of restenosis and other related ischemic cerebrovascular events during the 1-year postoperative follow-up.Results:Among the cases treated with subtotal occlusion by carotid artery stenting (CAS) with proximal blood flow protection device, 1 case failed and 2 cases received a secondary stent implantation. The surgeries on the patients with contralateral occlusion were performed with preoperative sedation, appropriate elevation of blood pressure, and shortening the vessel occlusion time. The patients with insufficient support due to path distortion received coaxial multi guide wire with multiple switching long sheath assisting technology. Among the patients with angular distortions at stenosis distal end, the stent was successfully released at the proximal in 2 cases, the stent was released across the angle without affecting the blood flow in 1 case, and in 1 case the stent releasing across the angle was given up during the surgery due to the distal artery kinking. A total of 34 surgeries were success (94.4%), with the stenosis severity reducing from (93.1±3.2)% (before) to (21.5±4.8)% (after). In 3 cases, the patients had transient aphasia and contralateral limb hemiplegia and ischemic symptoms during the operation. There was no cerebral hemorrhage, cerebral infarction, or no in-stent restenosis during the one-year follow-up.Conclusion:CAS treatment in complex severe carotid stenosis requires individualized surgical procedures and perioperative management. Appropriate surgical plan can ensure the success and safety of the surgery.