Faraglia V, Sbarigia E, Speziale F, Taurino M, Massa R, Fiorani P
Chair of Vascular Surgery, University of Rome, Italy.
Eur J Vasc Surg. 1990 Aug;4(4):385-9. doi: 10.1016/s0950-821x(05)80872-2.
The contribution of the external carotid artery to cerebral blood flow in the presence of an internal carotid occlusion or severe stenosis is well documented. This study was undertaken in order to try and exploit the external carotid artery as a collateral pathway to avoid cerebral ischaemia during carotid surgery. The main problem is to ascertain when the external carotid artery is relevant to cerebral perfusion, and to assess if the insertion of a shunt from the common to the external carotid artery is a useful way of ensuring adequate cerebral perfusion in patients with cerebral ischaemia during carotid clamping. In order to do this, it was necessary to assay the haemodynamic role of the external carotid artery by means of a technique which monitors cerebral function in a reliable way. We tried to evaluate this possibility by an intra-operative haemodynamic study during carotid surgery in 35 patients operated on under local anaesthesia. The insertion of a shunt between the common and external carotid artery was able to reverse brain ischaemia during clamping in four of eight patients with a neurological deficit during temporary carotid occlusion. In selected cases therefore cerebral protection with an external carotid shunt might be a valuable adjunct in the performance of carotid surgery.
颈内动脉闭塞或严重狭窄时，颈外动脉对脑血流的贡献已有充分记录。本研究旨在尝试利用颈外动脉作为侧支循环途径，以避免颈动脉手术期间的脑缺血。主要问题是确定颈外动脉何时与脑灌注相关，并评估从颈总动脉到颈外动脉插入分流管是否是确保颈动脉夹闭期间脑缺血患者脑灌注充足的有效方法。为了做到这一点，有必要通过一种可靠监测脑功能的技术来测定颈外动脉的血流动力学作用。我们试图通过对35例在局部麻醉下接受手术的患者进行颈动脉手术期间的术中血流动力学研究来评估这种可能性。在8例临时颈动脉闭塞时有神经功能缺损的患者中，有4例在夹闭期间通过在颈总动脉和颈外动脉之间插入分流管逆转了脑缺血。因此，在某些特定情况下，使用颈外动脉分流管进行脑保护可能是颈动脉手术中的一项有价值的辅助措施。
