中国脑血管病杂志Issue(8)：402-406,5.DOI:11.3969/j.issn.1672-5921.2014.08.003
颈动脉内膜切除术治疗颈动脉次全或完全闭塞患者的术中超声评估
Intraoperative ultrasound assessment of carotid endarterectomy for the treatment of patients with subtotal or complete occlusion of carotid artery
摘要
Abstract
Objective To analyze the correlations of vascular structure, hemodynamic changes and surgical recanalization of carotid endarterectomy ( CEA) for the treatment of subtotal or complete occlusion of carotid artery. Methods A total of 107 patients with carotid artery occlusive disease diagnosed at Beijing Xuanwu Hospital,Capital Medical University received CEA therapy from January 2005 to January 2014 and were enrolled retrospectively. According to the findings of introperative ultrasound,they were divided into either a recanalization group (n=86) or a non-recanalization group (n=21). Preoperative and intraoperative carotid artery diameter and blood flow velocity were compared and analyzed with carotid ultrasonography. Intraoperative detected vascular abnormalities, residual vascular stenosis rate, blood flow velocity and pulsatility index of the ipsilateral middle cerebral artery ( MCA) were documented. Results (1) The peak systolic velocity (PSV) (82 ± 32 cm/s and 60 ± 17 cm/s),mean velocity (MV) (50 ± 19 cm/s and 42 ±13cm/s),and pulsatility index (PI) (0. 97 ± 0. 25 and 0. 67 ± 0. 14) on the ipsilateral MCA in patients of carotid artery recanalization before and after procedure were significantly higher than those during the procedure. There were significant differences (all P=0. 000). In patients failed to recanalize,the intraoperative and preoperative PSV,EDV,and MV of MCA were 46 ± 20 cm/s and. 63 ± 21 cm/s,24 ± 13 cm/s and 34 ± 12 cm/s, and 32 ± 16 cm/s and 44 ± 15 cm/s,respectively. They were reduced more significantly during the procedure than those after procedure. There were significant differences ( all P=0. 000 ) . But there was no significant difference in PI (0. 70 ± 0. 18 and 0. 67 ± 0. 15) compared with that before procedure (P=0. 317). (2) The diseased vascular diameter of the recanalization group was significantly widened (0. 6 ± 0. 4 mm vs. 3. 4 ± 0. 9 mm,P=0. 000) compared with before procedure. The overall recanalization rate was 80. 4% (86/107). Intraoperative ultrasound revealed that 13 patients had mild abnormal vascular structures among the recanalized patients. The non-recanalized patients had significantly abnormal vascular structure. Conclusion Intraoperative carotid ultrasound in combination with transcranial Doppler (TCD) for monitoring cerebral blood flow may effectively identify the carotid structure and the degree of cerebral hemodynamic improvement,and timely guide the secondary repair.关键词
颈动脉疾病/颈动脉狭窄/颈动脉内膜切除术/术中超声评估Key words
Carotid artery disease/Carotid artery stenosis/Carotid endarterectomy/Intraoperative ultrasound assessment引用本文复制引用
刘玉梅,刘蓓蓓,孟秀峰,杨洁,李景植,李响,焦力群,华扬..颈动脉内膜切除术治疗颈动脉次全或完全闭塞患者的术中超声评估[J].中国脑血管病杂志,2014,(8):402-406,5.基金项目
首发专项基金课题(303-01-005-0077) （303-01-005-0077）
