Yun Woo-Sung
Division of Transplantation and Vascular Surgery, Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea.
Ann Surg Treat Res. 2017 Feb;92(2):105-109. doi: 10.4174/astr.2017.92.2.105. Epub 2017 Jan 31.
To evaluate the efficacy and safety of cerebral monitoring by transcranial Doppler ultrasonography (TCD) for the detection of cerebral ischemia during carotid endarterectomy (CEA).
From August 2004 to December 2013, 159 CEAs were performed in a tertiary hospital. All procedures were performed under general anesthesia. Intraoperative TCD was routinely used to detect cerebral ischemia. Of the 159 patients, 102 patients were included in this study, excluding 27 patients who had a poor transtemporal isonation window and 30 patients who used additional cerebral monitoring systems such as electroencephalography or somatosensory evoked potentials. When mean flow velocity in the ipsilateral middle cerebral artery decreased by >50% versus baseline during carotid clamping carotid shunting was selectively performed. The carotid shunt rate and incidence of perioperative (<30 days) stroke or death were investigated by reviewing medical records.
Carotid shunting was performed in 31 of the 102 patients (30%). Perioperative stroke occurred in 2 patients (2%); a minor ischemic stroke caused by embolism in one and an intracerebral hemorrhage in the other. Perioperative death developed in the latter patient.
TCD is a safe cerebral monitoring tool to detect cerebral ischemia during CEA. It can reduce use of carotid shunt.
评估经颅多普勒超声（TCD）在颈动脉内膜切除术（CEA）期间监测脑缺血的有效性和安全性。
2004年8月至2013年12月，一家三级医院共进行了159例CEA手术。所有手术均在全身麻醉下进行。术中常规使用TCD检测脑缺血。159例患者中，102例纳入本研究，排除27例颞窗透声不良的患者以及30例使用了诸如脑电图或体感诱发电位等其他脑监测系统的患者。当颈动脉夹闭期间同侧大脑中动脉平均血流速度较基线下降>50%时，选择性地进行颈动脉分流。通过查阅病历调查颈动脉分流率及围手术期（<30天）中风或死亡的发生率。
102例患者中有31例（30%）进行了颈动脉分流。围手术期有2例患者发生中风（2%）；1例为栓塞所致轻度缺血性中风，另1例为脑出血。后1例患者发生围手术期死亡。
TCD是CEA期间检测脑缺血的一种安全的脑监测工具。它可以减少颈动脉分流的使用。
