Bagan P, Azorin J, Salama J, Dumas J-L
Department of Thoracic and Vascular surgery, Avicenne Hospital, AP-HP, University Paris XIII, Bobigny, France.
Surg Radiol Anat. 2005 Dec;27(6):544-7. doi: 10.1007/s00276-005-0032-5. Epub 2005 Sep 1.
Cerebral perfusion during carotid cross-clamping depends on collateral function of the circle of Willis. The aim of this study was to determine the value of 3D Phase-Contrast (3D PC) MR angiography in predicting pre-operatively the need of shunting.
3D PC MR angiography were performed in 121 patients before carotid endarterectomy under locoregional anaesthesia. Based on the MR analysis, the risk of cerebral ischemia-hypoxia during clamping was classified as high, moderate and low. The analysis was then correlated with intraoperative neurological examination.
In patients with high risk of cerebral ischemia (n=9), immediate cerebral ischemia developed in all patients within one min of clamping (P<0.001). All nine underwent shunt placement. In six of the patients with moderate risk (n=46), cerebral ischemia occurred between 20 and 25 min after clamping; All occurred during intraoperative hypotension.
3D PC MR angiography can significantly determine the need of shunting in patients with important risk of immediate intraoperative cerebral ischemia. It also focuses on the intraoperative blood pressure stability in patients with moderate risk of ischemia.
颈动脉交叉阻断期间的脑灌注取决于 Willis 环的侧支循环功能。本研究的目的是确定三维相位对比（3D PC）磁共振血管造影在术前预测分流需求方面的价值。
在 121 例接受局部麻醉下行颈动脉内膜切除术的患者术前进行 3D PC 磁共振血管造影。基于磁共振分析，将阻断期间脑缺血缺氧的风险分为高、中、低三类。然后将该分析结果与术中神经学检查结果进行关联。
在脑缺血高风险患者（n = 9）中，所有患者在阻断后 1 分钟内均立即出现脑缺血（P < 0.001）。所有 9 例患者均接受了分流术。在中度风险患者中的 6 例（n = 46），脑缺血发生在阻断后 20 至 25 分钟之间；所有这些情况均发生在术中低血压期间。
3D PC 磁共振血管造影能够显著确定术中即刻发生脑缺血风险较高患者的分流需求。它还关注缺血中度风险患者术中的血压稳定性。
