Brosig Torge, Hoinkes Annika, Seitz Rudiger J, Sandmann Wilhelm, Huber Rita, Siebler Mario
Department of Neurology, Heinrich Heine University Dusseldorf, Dusseldorf, Germany.
Cerebrovasc Dis. 2008;26(1):87-92. doi: 10.1159/000136901. Epub 2008 Jun 6.
Cerebral microembolic signals (MES) after carotid endarterectomy (CEA) are associated with an increased risk of postoperative stroke. We investigated the relationship of an intraoperatively recorded ultrasound turbulence index (TI) during CEA and the occurrence of MES.
Short-time MES detection was performed on 164 patients (mean age 64 years, 140 males) in the ipsilateral middle cerebral artery within 2 h after CEA. A specialized continuous-wave ultrasound Doppler probe measured the TI within the reconstructed internal carotid artery during surgery.
The occurrence of postoperative MES increased significantly with the TI: a TI >26 predicted MES with a sensitivity of 72% and a specificity of 76%. The MES rate and TI were higher in patients operated with the eversion technique than in patients operated with the patch technique (p = 0.005). There was no relationship with preoperative MES, site of surgery or age of patients. Female patients had a higher risk of postoperative MES than males (p = 0.003).
Simplified intraoperative Doppler sonography or short-time MES detection after CEA are feasible, and may be helpful for surgical quality control and decision making (e.g. treatment with platelet antagonists).
颈动脉内膜剥脱术（CEA）后大脑微栓塞信号（MES）与术后中风风险增加相关。我们研究了CEA术中记录的超声湍流指数（TI）与MES发生之间的关系。
对164例患者（平均年龄64岁，140例男性）在CEA术后2小时内对同侧大脑中动脉进行短时间MES检测。手术期间，使用专门的连续波超声多普勒探头测量重建颈内动脉内的TI。
术后MES的发生率随TI显著增加：TI>26预测MES的敏感性为72%，特异性为76%。采用外翻技术手术的患者的MES率和TI高于采用补片技术手术的患者（p = 0.005）。与术前MES、手术部位或患者年龄无关。女性患者术后发生MES的风险高于男性（p = 0.003）。
简化的术中多普勒超声检查或CEA术后短时间MES检测是可行的，可能有助于手术质量控制和决策制定（如使用血小板拮抗剂治疗）。
