Sorteberg W, Sorteberg A, Lindegaard K F, Boysen M, Nornes H
Department of Neurosurgery, Rikshospitalet, The National Hospital, University of Oslo, Norway.
Neurosurgery. 1999 Jul;45(1):76-87; discussion 87-8. doi: 10.1097/00006123-199907000-00019.
To emphasize the integrated use of transcranial Doppler ultrasonography (TCD) in the management of internal carotid artery (ICA) closure.
Thirty-three patients being considered for ICA closure underwent TCD assessment, vasomotor reserve testing/estimation, and carotid artery test occlusion with concomitant middle cerebral artery (MCA) blood velocity (V(MCA)) monitoring, including calculation of the MCA pulsatility index. Twelve of these patients proceeded to undergo ICA sacrifice. Sequential TCD sonograms guided their postoperative treatment.
ICA aneurysms and neck neoplasms affected the TCD results and vasomotor reserve insignificantly, whereas carotid-cavernous fistulae induced characteristic circulatory alterations. The 10 subjects who tolerated ICA sacrifice hemodynamically all showed an initial decrease in the ipsilateral V(MCA) to > or =60% of the preocclusion value and a progressively decreasing MCA pulsatility index during carotid artery test occlusion. The two patients who developed hemodynamic cerebral infarctions exhibited a decrease in V(MCA) to <60% and a MCA pulsatility index that remained stable after a vast initial reduction. Postoperative hypervolemic and hypertensive support was safely titrated in all patients who received postoperative TCD surveillance, providing an ipsilateral V(MCA) of > or =80% of the preocclusion value. ICA closure permanently altered the cerebral circulatory pattern.
The hemodynamic outcome of ICA sacrifice can be correctly predicted by using the TCD occlusion test. TCD provides the means to titrate the extent of postoperative hypervolemic/hypertensive support.
强调经颅多普勒超声（TCD）在颈内动脉（ICA）闭塞治疗中的综合应用。
33例考虑行ICA闭塞术的患者接受了TCD评估、血管舒缩储备测试/评估以及颈动脉试验性闭塞并同步监测大脑中动脉（MCA）血流速度（V（MCA）），包括计算MCA搏动指数。其中12例患者继续接受了ICA结扎术。连续的TCD超声图指导了他们的术后治疗。
ICA动脉瘤和颈部肿瘤对TCD结果及血管舒缩储备影响不显著，而颈内动脉海绵窦瘘可引起特征性循环改变。10例血流动力学上耐受ICA结扎的受试者在颈动脉试验性闭塞期间均表现出同侧V（MCA）最初降至闭塞前值的≥60%，且MCA搏动指数逐渐降低。2例发生血流动力学性脑梗死的患者V（MCA）降至<60%，且MCA搏动指数在最初大幅降低后保持稳定。在所有接受术后TCD监测的患者中，均安全地调整了术后高血容量和高血压支持治疗，使同侧V（MCA）达到闭塞前值的≥80%。ICA闭塞永久性改变了脑循环模式。
使用TCD闭塞试验可正确预测ICA结扎的血流动力学结果。TCD提供了调整术后高血容量/高血压支持程度的方法。
