Cho Jayun, Lee Kyung Keun, Yun Woo-Sung, Kim Hyung-Kee, Hwang Yang-Ha, Huh Seung
Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea.
J Korean Surg Soc. 2013 Apr;84(4):238-44. doi: 10.4174/jkss.2013.84.4.238. Epub 2013 Mar 26.
To evaluate shunt rate and discuss the resultsrelated to selective shunt placement during carotid endarterectomy (CEA) using routine awake test.
Patients with CEA from 2007 to 2011 were retrospectively reviewed from prospectively collected data. The need for shunt placement was determined by the awake test, based on the alteration in the neurologic examination. We collected data by using the clinical records and imaging studies, and investigated factors related to selective shunt such as collateral circulation and contralateral internal carotid artery (ICA) stenosis.
There were 45 CEAs under regional anesthesia with the awake test in 44 patients. The mean age was 61.8 ± 7.1 years old. There were 82.2% (37/45) of males, and 68.9% (31/45) of symptomatic patients. Selective shunt placement had been performed in only two (4.4%) patients. Among them fewer cases (4%) had severe (stenosis >70%) contralateral ICA lesions, and more cases (91%) of complete morphology of the anterior or posterior circulation in the circle of Willis. There was no perioperative stroke, myocardial infarctionor death, and asymptomatic new brain lesions were detected in 4 patients (9%), including 2 cases of selective shunt placement.
CEA under routine awake test could besafe and feasible method with low shunt placement rate in selected patients.
使用常规清醒试验评估分流率，并讨论与颈动脉内膜切除术（CEA）期间选择性分流放置相关的结果。
对2007年至2011年接受CEA的患者进行回顾性研究，数据来自前瞻性收集。根据神经学检查的变化，通过清醒试验确定是否需要放置分流管。我们通过临床记录和影像学研究收集数据，并调查与选择性分流相关的因素，如侧支循环和对侧颈内动脉（ICA）狭窄。
44例患者在区域麻醉下进行了45例CEA清醒试验。平均年龄为61.8±7.1岁。男性占82.2%（37/45），有症状患者占68.9%（31/45）。仅2例（4.4%）患者进行了选择性分流放置。其中，对侧ICA严重病变（狭窄>70%）的病例较少（4%），Willis环前循环或后循环形态完整的病例较多（91%）。围手术期无中风、心肌梗死或死亡，4例（9%）患者检测到无症状性新脑病变，其中包括2例选择性分流放置患者。
在选定患者中，常规清醒试验下的CEA可能是一种安全可行的方法，分流放置率较低。
