Schwartz R A, Peterson G J, Noland K A, Hower J F, Naunheim K S
St. Louis University Hospital, Mo.
J Vasc Surg. 1988 May;7(5):620-4. doi: 10.1067/mva.1988.avs0070620.
The operative management of extracranial cerebrovascular occlusive disease requires meticulous surgical technique. Intraoperative duplex imaging (10 MHz B-mode ultrasound combined with 7.5 MHz Doppler spectrum analysis) was used in an attempt to recognize technical problems that might result in serious neurologic injury. Eighty-four carotid arteries were studied in 76 consecutive patients undergoing carotid endarterectomy or reconstruction. Indications for operation included carotid territory transient ischemic attack (n = 36 [43%]), amaurosis fugax (n = 16 [19%]), stroke (n = 11 [13%]), asymptomatic stenosis (n = 11 [13%]), vertebrobasilar transient ischemic attack (n = 7 [8%]), recurrent stenosis (n = 2 [2%]), and trauma (n = 1 [1%]). Arterial anatomy was assessed ultrasonographically and duplex-derived velocity measurements were obtained to assess hemodynamics. Increased velocity measurement was noted to correlate with ultrasound image of stenosis. Technical errors were identified in 17 patients (22%), including six persons with residual internal carotid artery stenoses, three persons with hemodynamically significant stenoses caused by "kinked" internal carotid arteries, eight persons with debris or intimal flaps in their external carotid arteries, and one person with an occluded external carotid artery. The intraoperative duplex scan led to corrective measures during the surgical procedure in eight patients (11%). No new ipsilateral brain injury was noted in the 76 patients postoperatively. Intraoperative duplex scanning accurately identified residual stenosis, intraluminal thrombus, and loose debris. Duplex scanning altered intraoperative decision making in a significant proportion of patients studied.
颅外脑血管闭塞性疾病的手术治疗需要精湛的手术技巧。术中使用双功成像（10兆赫B型超声结合7.5兆赫多普勒频谱分析），以识别可能导致严重神经损伤的技术问题。对76例连续接受颈动脉内膜切除术或重建术的患者的84条颈动脉进行了研究。手术指征包括颈动脉供血区短暂性脑缺血发作（n = 36 [43%]）、一过性黑矇（n = 16 [19%]）、中风（n = 11 [13%]）、无症状性狭窄（n = 11 [13%]）、椎基底动脉短暂性脑缺血发作（n = 7 [8%]）、复发性狭窄（n = 2 [2%]）和创伤（n = 1 [1%]）。通过超声检查评估动脉解剖结构，并获得双功衍生的速度测量值以评估血流动力学。发现速度测量值增加与狭窄的超声图像相关。在17例患者（22%）中发现了技术错误，包括6例颈内动脉残留狭窄患者、3例因颈内动脉“扭曲”导致血流动力学显著狭窄的患者、8例颈外动脉有碎片或内膜瓣的患者以及1例颈外动脉闭塞的患者。术中双功扫描导致8例患者（11%）在手术过程中采取了纠正措施。76例患者术后均未发现新的同侧脑损伤。术中双功扫描准确识别了残留狭窄、腔内血栓和松散碎片。双功扫描在很大一部分研究患者中改变了术中决策。
