Yamamoto K, Komiyama T, Miyata T, Kitagawa T, Momose T, Shigematsu H, Nagawa H
Unit of Vascular Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Int Angiol. 2004 Dec;23(4):388-93.
It is still controversial whether the existence of a contralateral stenosis is a risk factor during carotid endarterectomy (CEA). We used a near infrared spectroscopy (NIRS) monitoring system during CEA to evaluate the hemodynamic effect of contralateral stenosis during cross clamping of the carotid arteries.
We monitored 34 consecutive cases of CEA, using NIRS. Tissue oxygen index (TOI), as a parameter of oxygenation, and total hemoglobin index (THI), as a parameter of blood volume, were measured during cross-clamping the carotid arteries. We evaluated the relationship between these results and the pre- and intraoperative characteristics including the existence of a contralateral stenosis and the results of single-photon emission computed tomography (SPECT).
Bilateral TOI and THI correlated well with the severity of the stenosis of the contralateral internal carotid artery, and ipsilateral THI correlated with the cerebrovascular reserve measured by SPECT.
A contralateral stenosis is a risk factor for CEA from the hemodynamical point of view, and extreme care should be taken when performing CEA in patients with bilateral stenoses.
在颈动脉内膜切除术（CEA）期间，对侧狭窄的存在是否为危险因素仍存在争议。我们在CEA期间使用近红外光谱（NIRS）监测系统，以评估颈动脉交叉钳夹期间对侧狭窄的血流动力学效应。
我们使用NIRS连续监测34例CEA病例。在颈动脉交叉钳夹期间，测量作为氧合参数的组织氧合指数（TOI）和作为血容量参数的总血红蛋白指数（THI）。我们评估了这些结果与术前和术中特征之间的关系，包括对侧狭窄的存在以及单光子发射计算机断层扫描（SPECT）的结果。
双侧TOI和THI与对侧颈内动脉狭窄的严重程度密切相关，同侧THI与通过SPECT测量的脑血管储备相关。
从血流动力学角度来看，对侧狭窄是CEA的一个危险因素，在对双侧狭窄患者进行CEA时应格外小心。
