Belardi P, Lucertini G
Department of Vascular Surgery, University of Genoa, Genoa, Italy.
J Cardiovasc Surg (Torino). 2003 Dec;44(6):731-5.
Assessment of cerebrovasoreactivity (CVR), obtained by transcranial Doppler (TCD) and the acetazolamide test to predict cases requiring selective carotid shunting on the basis of neurologic monitoring.
A consecutive series of 87 carotid endarterectomy (CEA) cases was studied. Before surgery CVR was evaluated by measuring the mean velocity of the middle cerebral artery (mvMCA) using TCD at the basal condition and at 30 min after intravenous administration of acetazolamide (1 g). Carotid shunting was performed using neurologic monitoring under local anesthesia. Receiver operating characteristic (ROC) curve was calculated for sensitivity and specificity for various CVR cut offs.
The ROC curve demonstrated that there was no single CVR cut off with both sensitivity and specificity above 80%.
The present study, which employed neurologic monitoring as the method of comparison, did not prove that CVR, as calculated by TCD and the acetazolamide test, is a valid preoperative test for predicting cerebral ischaemia caused by carotid clamping.
通过经颅多普勒（TCD）和乙酰唑胺试验评估脑血管反应性（CVR），以基于神经监测预测需要选择性颈动脉分流的病例。
对连续的87例颈动脉内膜切除术（CEA）病例进行研究。手术前，通过在基础状态下以及静脉注射乙酰唑胺（1g）后30分钟使用TCD测量大脑中动脉的平均速度（mvMCA）来评估CVR。在局部麻醉下使用神经监测进行颈动脉分流。计算不同CVR截断值的敏感性和特异性的受试者操作特征（ROC）曲线。
ROC曲线表明，不存在敏感性和特异性均高于80%的单一CVR截断值。
本研究采用神经监测作为比较方法，并未证明通过TCD和乙酰唑胺试验计算得出的CVR是预测颈动脉夹闭引起的脑缺血的有效术前检查。
