Spacek M, Stechovsky C, Horvath M, Hajek P, Zimolova P, Veselka J
Department of Cardiology, Motol University Hospital, Second Medical School, Charles University, Prague, Czech Republic.
Physiol Res. 2016;65(1):71-9. doi: 10.33549/physiolres.933077. Epub 2015 Nov 24.
We investigated the usefulness of cerebrovascular reserve (CVR) testing to predict severe hemodynamic changes during proximally protected carotid artery stenting. Of 90 patients referred, 63 eligible underwent complete evaluation of the extent of carotid artery disease and transcranial Doppler ultrasound (TCD) assessment of CVR by means of a breath-holding test and ophthalmic artery flow pattern evaluation. Periprocedural TCD monitoring of the ipsilateral middle cerebral artery flow was performed in 24 patients undergoing proximally protected procedure (requiring induction of flow arrest within internal carotid artery). Abnormal CVR was significantly less common in patients with unilateral compared to bilateral carotid artery disease (26.3 % vs. 76.9 %, p=0.02), while ophthalmic artery flow reversal was rare in patients with unilateral carotid artery disease (2.5 % vs. 42.9 %, p<0.01). During the induction of carotid flow arrest, the average mean flow velocity drop following external carotid artery occlusion was low (3.5 %, p=0.67) compared to the induction of complete flow arrest (32.8 %, p<0.01). Six patients had a total mean flow velocity drop >50 %, including 2 patients with normal pre-procedural CVR. Our results suggest that TCD evaluation of CVR is not a reliable predictor of hemodynamic changes induced during proximally protected carotid artery stenting in patients with unilateral carotid artery disease.
我们研究了脑血管储备（CVR）测试对预测近端保护型颈动脉支架置入术中严重血流动力学变化的有效性。在90例转诊患者中，63例符合条件，接受了颈动脉疾病范围的全面评估以及通过屏气试验和眼动脉血流模式评估对CVR进行的经颅多普勒超声（TCD）评估。对24例接受近端保护手术（需要诱导颈内动脉血流停止）的患者进行了同侧大脑中动脉血流的围手术期TCD监测。与双侧颈动脉疾病患者相比，单侧颈动脉疾病患者中CVR异常的情况明显较少见（26.3%对76.9%，p=0.02），而单侧颈动脉疾病患者中眼动脉血流逆转的情况很少见（2.5%对42.9%，p<0.01）。在诱导颈动脉血流停止期间，与诱导完全血流停止（32.8%，p<0.01）相比，颈外动脉闭塞后平均血流速度下降较低（3.5%，p=0.67）。6例患者的平均血流速度总下降>50%，其中2例术前CVR正常。我们的结果表明，对于单侧颈动脉疾病患者，TCD评估CVR并不是近端保护型颈动脉支架置入术中诱导的血流动力学变化的可靠预测指标。
