Forbes K P, Shill H A, Britt P M, Zabramski J M, Spetzler R F, Heiserman J E
Divisions of Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
AJNR Am J Neuroradiol. 2001 Apr;22(4):650-3.
Transcranial Doppler studies have suggested that microemboli are released into the arterial circulation during the majority of carotid endarterectomy (CEA) procedures. This, together with the observation that neuropsychological performance may decline postoperatively, has led to concern that cerebral infarction may occur unrecognized during CEA. Our objective was to examine this risk with diffusion-weighted imaging, a technique that is highly sensitive to acute cerebral infarction.
Eighteen participants (median age, 68 years; age range, 56-87 years) were assessed with diffusion-weighted imaging and the National Institutes of Health Stroke Scale before and after CEA. Imaging was performed using single-shot echo-planar imaging with a maximum diffusion sensitivity of b = 1000 s/mm(2) applied to three orthogonal planes. Preoperative imaging was performed a median of 2.5 hours before surgery (range, 0.5-12.5 hours) and 15 hours after surgery (range, 1.5-58.5 hours). Two neuroradiologists independently interpreted the diffusion-weighted images, blinded to operative status and clinical findings.
There was no diffusion-weighted imaging evidence of silent embolism in this series of 18 participants (95% confidence interval limits, 0 to 10%). Clinical complications were confined to one case of confusion occurring after CEA; the diffusion-weighted imaging results were normal in this case.
There is no evidence from our series that silent cerebral infarction is a common occurrence during CEA. These data provide further support for the safety of CEA.
经颅多普勒研究表明，在大多数颈动脉内膜切除术（CEA）过程中，微栓子会释放到动脉循环中。这一现象，再加上术后神经心理表现可能下降的观察结果，引发了人们对CEA期间可能未被识别的脑梗死发生的担忧。我们的目的是使用对急性脑梗死高度敏感的弥散加权成像技术来研究这种风险。
18名参与者（年龄中位数为68岁；年龄范围为56 - 87岁）在CEA前后接受了弥散加权成像和美国国立卫生研究院卒中量表评估。成像采用单次激发回波平面成像，最大弥散敏感度b = 1000 s/mm(2)，应用于三个正交平面。术前成像在手术前中位数2.5小时（范围为0.5 - 12.5小时）进行，术后15小时（范围为1.5 - 58.5小时）进行。两名神经放射科医生在对手术状态和临床发现不知情的情况下独立解读弥散加权图像。
在这18名参与者的系列研究中，没有弥散加权成像证据显示存在无症状栓塞（95%置信区间范围为0至10%）。临床并发症仅限于1例CEA后出现的意识模糊病例；该病例的弥散加权成像结果正常。
我们的系列研究没有证据表明无症状脑梗死在CEA期间是常见现象。这些数据为CEA的安全性提供了进一步支持。
