DETECTION OF MIDDLE CEREBRAL-ARTERY EMBOLI DURING CAROTID ENDARTERECTOMY USING TRANSCRANIAL DOPPLER ULTRASONOGRAPHY
DETECTION OF MIDDLE CEREBRAL-ARTERY EMBOLI DURING CAROTID ENDARTERECTOMY USING TRANSCRANIAL DOPPLER ULTRASONOGRAPHY
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DOI：
10.1161/01.str.21.3.415
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发表时间：
1990-03-01
期刊：
影响因子：
8.3
通讯作者：
SAUVAGE, LR
中科院分区：
文献类型：
--
作者：
SPENCER, MP;THOMAS, GI;SAUVAGE, LR
本研究的目的是明确2 MHz脉冲经颅多普勒超声在颈动脉内膜切除术患者中发现大脑中动脉血栓的信号特征和临床情况。指定栓子的信号是显示谐波性质的瞬时信号，其特征明显不同于机械和电子伪像的特征。我们回顾了91名患者的音频/视频磁带记录，以寻找在解除颈总动脉夹闭时出现气泡栓子的信号；35名患者(38%)的录音显示有气泡栓子。当血流中不可能出现气泡时，也可以发现具有与气泡栓子相同特征的瞬变；我们将这些瞬变定义为代表形成的元素栓子。在24名患者(26%)的记录中发现了这种信号，这些信号发生在手术解剖前(自发和颈总动脉压迫时)、手术中和手术后。提示形成元素栓子的信号与管腔内血小板血栓、颈动脉溃疡、短暂性脑缺血发作或中风有关。大多数术后形成的元素栓子不会引起症状，但当持续数小时时，它们与中风和脑梗塞有关。这种检测栓子的多普勒超声方法将在卒中机制的研究中有用，并作为一种临床测试来指导有卒中风险的患者的内科和外科治疗。
The purpose of our study was to define the signal characteristics and clinical circumstances associated with emboli detected in the middle cerebral artery using 2-MHz pulsed transcranial Doppler ultrasound in patients undergoing carotid endarterectomy. Signals designating emboli were transients displaying harmonic qualities the signatures of which were clearly different from those of mechanical and electronic artifacts. We reviewed the audio/video tape recordings from 91 patients for signals of air bubble emboli occurring upon release of common carotid artery crossclamps; recordings from 35 patients (38%) demonstrated air bubble emboli. Transients with signatures identical to those of air bubble emboli were also discovered when bubbles in the bloodstream were improbable; we defined these transients as representing formed-element emboli. Such signals were found in recordings from 24 patients (26%), and they occurred before (both spontaneously and upon common carotid artery compression), during, and after surgical dissection. Signals indicating formed-element emboli were associated with intraluminal platelet thrombus, with ulcerations in the carotid artery, and with transient ischemic attacks or stroke. Most postoperative formed-element emboli did not cause symptoms, but, when persisting for hours, they were associated with strokes and cerebral infarction. This doppler ultrasound method of detecting emboli will be useful in the study of stroke mechanisms and as a clinical test to guide the medical and surgical treatment of patients at risk of stroke.