Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
Oper Neurosurg (Hagerstown). 2017 Dec 1;13(6):739-745. doi: 10.1093/ons/opw036.
Intraoperative computed tomography angiography (ICTA) is a novel completion imaging modality for carotid endarterectomy (CEA). No studies exist in the literature describing ICTA use in CEA.
To evaluate the feasibility and efficacy of ICTA as a method of immediately evaluating the technical results of CEA.
Twenty-three consecutive CEAs were performed by a single neurosurgeon over an 8-month period. Of this series, 12 utilized ICTA for completion imaging, 10 utilized duplex ultrasonography (US), and 1 utilized no intraoperative completion imaging. Electronic medical records were reviewed to assess demographics, CTA results, US results, and need for revisions.
Patients included 13 men (62%) and 8 women (38%). All patients had symptomatic internal carotid artery stenosis. Polytetrafluoroethylene (PTFE) patch angioplasty was used in 16 cases (70%). Average operative times were comparable between cases that utilized CTA and US, 180 and 175 min, respectively. Major technical defects were identified in one of the 12 cases utilizing ICTA and none of the 10 cases utilizing intraoperative US. The technical defect was revised without subsequent neurological complication. One patient had a postoperative intracerebral hemorrhage requiring surgical evacuation. Fifteen patients were followed for up to 3 months with no postoperative stroke or transient ischemic attacks.
ICTA is a potentially safe and effective completion imaging modality compared to traditional alternatives, enabling the identification of technical deficits intraoperatively. While no statistically significant difference in operative times were noted between intraoperative CTA and US use, numerous steps must be taken to maximize the efficiency of ICTA.
术中计算机断层血管造影（ICTA）是颈动脉内膜切除术（CEA）的一种新型完成成像方式。目前文献中尚无描述 ICTA 在 CEA 中应用的研究。
评估 ICTA 作为评估 CEA 技术结果的即时评估方法的可行性和有效性。
在 8 个月的时间内，由一名神经外科医生对 23 例连续的 CEA 进行了手术。在这一系列中，有 12 例使用 ICTA 进行完成成像，10 例使用双功能超声（US），1 例未使用术中完成成像。回顾电子病历以评估人口统计学、CTA 结果、US 结果和修订需求。
患者包括 13 名男性（62%）和 8 名女性（38%）。所有患者均有症状性颈内动脉狭窄。16 例（70%）使用聚四氟乙烯（PTFE）补丁血管成形术。使用 ICTA 和 US 的病例的平均手术时间分别为 180 分钟和 175 分钟，两者之间无显著差异。在使用 ICTA 的 12 例病例中发现了 1 例主要技术缺陷，而在使用术中 US 的 10 例病例中均未发现。在没有随后发生神经并发症的情况下对技术缺陷进行了修正。1 例患者术后出现脑出血，需手术清除。15 例患者接受了长达 3 个月的随访，无术后卒中和短暂性脑缺血发作。
与传统替代方法相比，ICTA 是一种潜在安全有效的完成成像方式，可在术中识别技术缺陷。虽然术中 CTA 和 US 使用之间的手术时间无统计学显著差异，但必须采取许多步骤来最大限度地提高 ICTA 的效率。
