Benichou H, Bergeron P, Ferdani M, Jausseran J M, Reggi M, Courbier R
Service de Chirurgie Cardiovasculaire, Fondation Hôpital Saint-Joseph, Marseille, France.
Ann Vasc Surg. 1991 Jan;5(1):21-5. doi: 10.1007/BF02021772.
We report 91 patients (mean age 70 years) operated upon, prospectively for a total of 100 carotid revascularizations (nine bilateral). Eighty-five of these patients had pre-, intra-, and postoperative transcranial Doppler investigations. Preoperatively, these 85 patients (92 procedures) were classified into two groups based on the results of their Doppler examinations: Group A (65 patients, 72 procedures), those who did not require an intraoperative indwelling shunt and Group B (20 patients, 20 procedures), those who did. The shunt was inserted only when the mean stump (back) pressure was less than 50 mmHg after cross-clamping. Group A all had satisfactory collaterality with a functional anterior and one or two posterior communicating arteries. Group B had no communicating arteries (anterior or posterior) identified by transcranial Doppler. In 17 of 20 patients in this group, the stump pressure was less than 50 mmHg and a shunt was placed. The overall prediction based on Doppler examination of whether or not patients would need a shunt during operation for the two groups A and B (i.e., 92 procedures) was correct in 95.6% (88/92) of cases. Moreover, six hemodynamically significant stenoses (four in the cavernous portion, two in the middle cerebral artery) were disclosed. Sensitivity and specificity of transcranial Doppler as correlated with arteriographic findings were 70 and 90%. Preoperative transcranial Doppler can measure the velocities of the principal cerebral arteries and the collateral capacity of the circle of Willis, and can forecast tolerance to carotid cross-clamping. Intraoperatively, the velocity of flow in the middle carotid artery was correlated with stump pressure, which allowed for surveillance of the shunt.
我们前瞻性地报告了91例接受手术的患者（平均年龄70岁），共进行了100次颈动脉血运重建术（9例为双侧手术）。其中85例患者进行了术前、术中和术后的经颅多普勒检查。术前，根据多普勒检查结果，这85例患者（92次手术）被分为两组：A组（65例患者，72次手术），这些患者术中不需要留置分流管；B组（20例患者，20次手术），这些患者术中需要留置分流管。仅在夹闭后平均残端（回）压低于50 mmHg时才插入分流管。A组所有患者均具有满意的侧支循环，其前交通动脉和一或两条后交通动脉功能正常。B组经颅多普勒未发现交通动脉（前交通或后交通）。该组20例患者中有17例残端压低于50 mmHg并放置了分流管。基于多普勒检查对A组和B组患者（即92次手术）术中是否需要分流管的总体预测在95.6%（88/92）的病例中是正确的。此外，还发现了6处具有血流动力学意义的狭窄（4处位于海绵窦段，2处位于大脑中动脉）。经颅多普勒与血管造影结果相关的敏感性和特异性分别为70%和90%。术前经颅多普勒可测量大脑主要动脉的血流速度以及 Willis 环的侧支循环能力，并可预测对颈动脉夹闭的耐受性。术中，颈内动脉中部的血流速度与残端压相关，这有助于对分流管进行监测。
