THE SIGNIFICANCE OF MICROEMBOLI DETECTION BY MEANS OF TRANSCRANIAL DOPPLER ULTRASONOGRAPHY MONITORING IN CAROTID ENDARTERECTOMY
THE SIGNIFICANCE OF MICROEMBOLI DETECTION BY MEANS OF TRANSCRANIAL DOPPLER ULTRASONOGRAPHY MONITORING IN CAROTID ENDARTERECTOMY
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DOI：
10.1016/s0741-5214(95)70224-5
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发表时间：
1995-06-01
影响因子：
4.3
通讯作者：
MAUSER, HW
中科院分区：
文献类型：
--
作者：
ACKERSTAFF, RGA;JANSEN, C;MAUSER, HW
目的：通过连续经颅多普勒监测进行颈动脉内膜切除术（CEA）提供了一个独特的机会来确定脑微栓子的数量并将其发生与手术技术联系起来。本研究的目的是评估 CEA 中脑微栓塞对临床结果和大脑结构的影响。我们还评估了可听经颅多普勒信号对外科医生及其技术的影响。方法：在一项由 301 名患者组成的前瞻性系列研究中，通过同侧大脑中动脉的脑电图和经颅多普勒超声检查来监测 CEA。将术前和术中危险因素输入逻辑回归分析程序，以评估它们与脑部结局的相关性。为了评估脑微栓塞对大脑结构的影响，我们比较了两个亚组（分别为 58 名和 40 名患者）的术前和术后脑部计算机断层扫描或磁共振图像。结果：7 名（2.3%）患者出现术中短暂性脑缺血症状，3 名（1%）患者出现术中卒中，1 名（0.3%）术后出现短暂性脑缺血症状。 手术后，10 人（3.3%）发生术后中风。倒（1.3%）患者死亡。解剖过程中发现的微栓子 (>10) 与术中 (P < 0.002) 和术后 (p < 0.02) 脑并发症有关。分流过程中发生的微栓子也与术中并发症相关（P < 0.007）。术后计算机断层扫描中微栓塞从未导致新的形态变化。相反，解剖过程中微栓子超过10个的现象与术后T2加权磁共振图像上新出现的高信号病灶显着相关（P < 0.005）。结论：CEA期间解剖过程中微栓子（>10个微栓子）的存在与围手术期脑部并发症以及磁共振上新出现的缺血性病灶有统计学意义的相关性。 大脑的图像。此外，分流过程中的微栓塞也与术中并发症有关。外科医生可以通过改变技术来接受音频多普勒和栓塞信号的指导。这种变化可能会导致微栓塞减少，从而降低术中卒中发生率。
Purpose: Carotid endarterectomy (CEA) performed with continuous transcranial Doppler monitoring provides a unique opportunity to determine the number of cerebral microemboli and to relate their occurrence to the surgical technique. The purpose of this study was to assess in CEA the impact of cerebral microembolism on clinical outcome and brain architecture. We also evaluated the influence of the audible transcranial Doppler signal on the surgeon and his or her technique.Methods: In a prospective series of 301 patients, CEA was monitored with electroencephalography and transcranial Doppler ultrasonography of the ipsilateral middle cerebral artery. Preoperative and intraoperative risk factors were entered in a logistic regression analysis program to assess their correlation with cerebral outcome. To evaluate the impact of cerebral microembolism on brain architecture, we compared preoperative and postoperative computed tomography scans or magnetic resonance images of the brain in two subgroups of 58 and 40 patients, respectively.Results: Seven (2.3%) patients had intraoperative transient ischemic symptoms, three (1%) had intraoperative strokes, 1 (0.3%) had transient ischemic symptoms after operation, and 10 (3.3%) had postoperative strokes. Pour (1.3%) patients died. Microemboli (>10) noticed during dissection were related to both intraoperative (P < 0.002) and postoperative (p < 0.02) cerebral complications. Microemboli that occurred during shunting were also related to intraoperative complications (P < 0.007). Microembolism never resulted in new morphologic changes on postoperative computed tomography scans. On the contrary, the phenomenon of more than 10 microemboli during dissection was significantly (P < 0.005) related to new hyperintense lesions on postoperative T2-weighted magnetic resonance images.Conclusions: During CEA the presence of microembolism (>10 microemboli) during dissection shows a statistically significant relationship with perioperative cerebral complications and with new ischemic lesions on magnetic resonance images of the brain. Moreover, microembolism during shunting is also related to intraoperative complications. Surgeons can be guided by the audio Doppler and emboli signals by changing their technique. This change may result in a decrease of microembolism and consequently in a decline of the intraoperative stroke rate.