Sfyroeras George S, Bessias Nikolaos, Moulakakis Konstantinos G, Lyra Stavroula, Kotsikoris Ioannis, Andrikopoulos Vassilios, Liapis Christos D
Department of Vascular Surgery, Red Cross Hospital of Athens, Athens, Greece.
Ann Vasc Surg. 2013 Oct;27(7):883-7. doi: 10.1016/j.avsg.2012.10.019. Epub 2013 Jun 20.
We sought to investigate the incidence and location of new cerebral ischemic lesions after carotid endarterectomy (CEA) using diffusion-weighted magnetic resonance imaging (DW-MRI).
Sixty-six consecutive patients (50 males with a mean [±SD] age of 69 ± 9 years) who underwent CEA were included in this prospective study. Seventeen patients were symptomatic and 49 patients were asymptomatic. CEA was performed with patch closure without using a shunt. Carotid plaque echostructure was evaluated with the grayscale median (GSM) score. DW-MRI scanning of the brain was performed 24 hours before and 48 to 72 hours after the procedure.
Thirty-day stroke and mortality rates were 0%. The mean GSM score for symptomatic patients was 27 ± 15; for asymptomatic patients, the mean GSM score was 39 ± 18 (P = 0.006). Patients were divided into 2 groups according to GSM score: GSM scores ≤25 (22 patients) and GSM scores >26 (44 patients). New brain lesions were detected after 6 endarterectomies (8.9%), and all were clinically silent. These lesions were ischemic in 5 cases (7.5%) and micro-hemorrhagic in 1 case (1.4%). In 3 cases, new ischemic lesions were located within the treated carotid artery territory. In 2 cases, new lesions on DW-MRI were located outside of the treated carotid artery territory. There was no significant difference in the incidence of ischemic lesions between the 2 groups (GSM scores ≤25, 2 lesions; GSM scores >26, 3 lesions; P = 0.544).
New ischemic lesions on DW-MRI are detected in 7.5% of patients after CEA, and most of these lesions are clinically silent. Plaque echogenicity does not affect their incidence. New lesions seen on DW-MRI may be generated outside of the treated carotid artery territory.
我们试图利用扩散加权磁共振成像（DW-MRI）研究颈动脉内膜切除术（CEA）后新的脑缺血性病变的发生率及位置。
本前瞻性研究纳入了66例连续接受CEA的患者（50例男性，平均年龄[±标准差]为69±9岁）。17例患者有症状，49例患者无症状。CEA采用补片修补术，未使用分流管。用灰阶中位数（GSM）评分评估颈动脉斑块回声结构。术前24小时及术后48至72小时进行脑部DW-MRI扫描。
30天的卒中及死亡率均为0%。有症状患者的平均GSM评分为27±15；无症状患者的平均GSM评分为39±18（P = 0.006）。根据GSM评分将患者分为两组：GSM评分≤25（22例患者）和GSM评分>26（44例患者）。6例内膜切除术后检测到新的脑病变（8.9%），均无临床症状。这些病变中5例为缺血性（7.5%），1例为微出血性（1.4%）。3例中，新的缺血性病变位于治疗侧颈动脉供血区域内。2例中，DW-MRI上的新病变位于治疗侧颈动脉供血区域外。两组之间缺血性病变的发生率无显著差异（GSM评分≤25，2个病变；GSM评分>26，3个病变；P = 0.544）。
CEA术后7.5%的患者在DW-MRI上检测到新的缺血性病变，且大多数病变无临床症状。斑块回声不影响其发生率。DW-MRI上看到的新病变可能在治疗侧颈动脉供血区域外产生。
