Nguyen Thelinh Q, Lind Linda, Harris E John
Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Vascular. 2005 Jan-Feb;13(1):23-7. doi: 10.1258/rsmvasc.13.1.23.
Carotid endarterectomy (CEA) is an effective treatment for significant carotid atherosclerosis. Perioperative stroke, a devastating complication, may be partially circumvented by shunting. However, routine shunt use is not without complications and does not benefit every patient. Our study is designed to determine whether CEA under general anesthesia, without cerebral monitoring, can be safely done with shunting only in the presence of poor internal carotid artery back-bleeding or contralateral carotid occlusion or critical stenosis. The medical records of 995 carotid operations were reviewed. A subset of 117 operations was performed on 112 patients using selective shunting. Data were analyzed and outcomes compared. For the selective shunt group, indications for redo operations (n=13) were recurrent asymptomatic high-grade stenosis in 69% and amaurosis fugax or transient ischemic attack in 31%. Indications for primary CEA (n=104) were asymptomatic high-grade stenosis in 59%, amaurosis fugax or transient ischemic attack in 36%, previous stroke in 3%, and global ischemia in 2%. A selective shunt was used in 29% of all symptomatic and 11% of all asymptomatic patients. No cerebral monitoring was used. There were no perioperative deaths and no permanent cranial nerve injuries, and there was one stroke (0.8%) from postoperative carotid thrombosis in a shunted patient. The average length of stay was 1.6 days for the non-shunt group and 2.2 days for the shunt group. The routine shunt group (n=878) had an overall stroke rate of 0.7%, no permanent cranial nerve deficits, and a mean hospital stay of 2.6 days. CEA under general anesthesia with selective shunting can be performed safely without cerebral monitoring.
颈动脉内膜切除术（CEA）是治疗严重颈动脉粥样硬化的有效方法。围手术期卒中是一种灾难性并发症，分流术可部分避免该并发症。然而，常规使用分流术并非没有并发症，也并非对每个患者都有益。我们的研究旨在确定在全身麻醉下，不进行脑监测的情况下，仅在颈内动脉回血不良、对侧颈动脉闭塞或严重狭窄时进行分流，CEA手术是否能安全进行。回顾了995例颈动脉手术的病历。对112例患者进行的117例手术采用了选择性分流术。对数据进行分析并比较结果。对于选择性分流组，再次手术（n = 13）的指征为69%的复发性无症状重度狭窄和31%的一过性黑矇或短暂性脑缺血发作。初次CEA手术（n = 104）的指征为59%的无症状重度狭窄、36%的一过性黑矇或短暂性脑缺血发作、3%的既往卒中以及2%的全脑缺血。所有有症状患者中有29%、所有无症状患者中有11%使用了选择性分流术。未进行脑监测。没有围手术期死亡病例，也没有永久性脑神经损伤，有1例分流患者因术后颈动脉血栓形成发生卒中（0.8%）。非分流组的平均住院时间为1.6天，分流组为2.2天。常规分流组（n = 878）的总体卒中率为0.7%，没有永久性脑神经功能缺损，平均住院时间为2.6天。在全身麻醉下采用选择性分流术进行CEA手术，不进行脑监测也可安全实施。
