Unstable carotid plaques: Preoperative identification and association with intraoperative embolisation detected by transcranial Doppler
Unstable carotid plaques: Preoperative identification and association with intraoperative embolisation detected by transcranial Doppler
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DOI：
10.1016/s1078-5884(96)80139-0
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发表时间：
1996-01-01
影响因子：
5.7
通讯作者：
Naylor, AR
中科院分区：
文献类型：
--
作者：
Gaunt, ME;Brown, L;Naylor, AR
目的：调查颈动脉内膜切除术 (CEA) 期间颈动脉分叉处初次解剖过程中，通过术前彩色多普勒超声 (CDU) 和术后组织学检查确定的不稳定颈动脉斑块特征是否与经颅多普勒 (TCD) 检测到的颗粒栓塞相关。设计：对 50 名接受颈动脉内膜切除术 (CEA) 的患者进行了一项前瞻性连续研究。地点：莱斯特英国莱斯特皇家医院材料：术前使用 CDU 评估颈动脉斑块。使用 Scimed 2MHz TCD 对同侧大脑中动脉进行术中 TCD 监测。对手术中取出的颈动脉斑块进行组织学处理，并在显微镜下评估多个切片。主要结果测量：根据Gray-Weale分类对斑块成分进行超声和组织学分类，并根据五点分类对斑块表面特征进行分级。在动脉初始解剖过程中，TCD 检测到的栓塞被识别并计数。主要结果： 9 名患者发生颗粒栓塞。组织学上，3 例栓塞与溃疡斑块相关，6 例溃疡斑块与血栓相关（p = 0.0005）。然而，CDU 基于对不稳定斑块表面的正确识别而积极预测栓塞的能力仅为 25%。结论：解剖过程中的栓塞与溃疡斑块和相关血栓密切相关。 CDU 无法在术前可靠地识别这些特征。术中 TCD 监测可以在此阶段检测潜在有害的栓塞，从而能够适当修改手术技术。
Objectives: To investigate whether unstable carotid plaque characteristics, as determined by preoperative colour Duplex ultrasonography (CDU) and postoperative histological examination, were associated with particulate embolisation, detected by transcranial Doppler (TCD), during the initial dissection of the carotid bifurcation during carotid endarterectomy(CEA).Design: A prospective, consecutive study was undertaken of 50 patients undergoing carotid endarterectomy(CEA).Setting: Leicester Royal Infirmary, Leicester, U.K.Materials: Carotid plaques were assessed preoperatively using CDU. Intraoperative TCD monitoring of the ipsilateral middle cerebral artery was performed using a Scimed 2MHz TCD. Carotid plaques removed at operation were processed histologically and multiple sections assessed microscopically.Chief outcome measures: Plaque composition tons classified ultrasonically and histologically according to the Gray-Weale classification and plaque surface characteristics were graded according to a five point classification. TCD detected emboli were identified and counted dui during the initial dissection of the artery.Main results: Particulate embolisation occurred in nine patients. Histologically, embolisation was associated with ulcerated plaque in three cases and ulcerated plaque with associated thrombus in six cases (p = 0.0005). However, the ability of CDU to positively predict embolisation based on the correct identification of an unstable plaque surface was only 25%.Conclusions: Embolisation during dissection is strongly associated with ulcerated plaque with associated thrombus. CDU is unable to reliably identify these characteristics preoperatively. Intraoperative TCD monitoring can detect potentially harmful embolisation during this stage enabling surgical technique to be modified appropriately.