Lennard N, Smith J L, Gaunt M E, Abbott R J, London N J, Bell P R, Naylor A R
Department of Vascular Surgery, Leicester Royal Infirmary, U.K.
Eur J Vasc Endovasc Surg. 1999 Mar;17(3):234-40. doi: 10.1053/ejvs.1998.0723.
A pilot study in our unit suggested that a combination of transcranial Doppler (TCD) plus completion angioscopy reduced incidence of intra-operative stroke (i.e. patients recovering from anaesthesia with a new deficit) during carotid endarterectomy (CEA). The aim of the current study was to see whether routine implementation of this policy was both feasible and associated with a continued reduction in the rate of intraoperative stroke (IOS).
Prospective study in 252 consecutive patients undergoing carotid endarterectomy between March 1995 and December 1996.
Continuous TCD monitoring was possible in 229 patients (91%), while 238 patients (94%) underwent angioscopic examination. Overall, angioscopy identified an intimal flap requiring correction in six patients (2.5%), whilst intraluminal thrombus was removed in a further six patients (2.5%). No patient in this series recovered from anaesthesia with an IOS, but the rate of postoperative stroke was 2.8%.
Our policy of TCD plus angioscopy has continued to contribute towards a sustained reduction in the risk of IOS following CEA, but requires access to reliable equipment and technical support. However, a policy of intraoperative quality control assessment may not necessarily alter the rate of postoperative stroke.
我们科室的一项初步研究表明，经颅多普勒（TCD）联合血管内镜检查可降低颈动脉内膜切除术（CEA）期间术中卒中（即麻醉苏醒后出现新的神经功能缺损的患者）的发生率。本研究的目的是探讨常规实施该策略是否可行，以及是否能持续降低术中卒中（IOS）的发生率。
对1995年3月至1996年12月期间连续接受颈动脉内膜切除术的252例患者进行前瞻性研究。
229例患者（91%）可行连续TCD监测，238例患者（94%）接受了血管内镜检查。总体而言，血管内镜检查发现6例患者（2.5%）存在需要纠正的内膜瓣，另有6例患者（2.5%）清除了腔内血栓。本系列中没有患者麻醉苏醒后出现术中卒中，但术后卒中发生率为2.8%。
我们采用的TCD联合血管内镜检查策略持续有助于持续降低CEA术后术中卒中的风险，但需要可靠的设备和技术支持。然而，术中质量控制评估策略不一定会改变术后卒中的发生率。
