Myrcha Piotr, Lewczuk Andrzej, Jakuciński Maciej, Kozak Mariusz, Siemieniuk Dawid, Różański Dorota, Koziorowski Dariusz, Woźniak Witold
Chair and Clinic of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, W02-091 Warsaw, Poland.
Department of General, Vascular and Oncological Surgery, Masovian Brodnowski Hospital, 03-242 Warsaw, Poland.
J Clin Med. 2020 Dec 2;9(12):3913. doi: 10.3390/jcm9123913.
Carotid endarterectomy (CEA) is safe and effective in reducing the risk of stroke in symptomatic severe carotid artery stenosis. Having information about cross-clamping (CC) intolerance before surgery may reduce the complication rate. The purpose of this study was to assess the usefulness of magnetic resonance angiography (MRA) and magnetic resonance angiography perfusion (P-MR) in determining the risk of CC intolerance during CEA.
40 patients after CEA with CC intolerance were included in Group I, and 15 with CC tolerance in Group II. All patients underwent MRA of the circle of Willis (CoW), P-MR with or without Acetazolamide; P(A)-MR in the postoperative period.
CoW was normal in the MRA in three cases (7.5%) in Group I, and in eight (53%) in Group II. We found P-MR abnormalities in all patients from Group I and in 40% from Group II. Using a calculated cut-off point of 0.322, the patients were classified as CC tolerant with 100% sensitivity or as CC intolerant with 95% specificity. After evaluating P-MR or MRA alone, the percentage of false negative results significantly increased.
The highest value in predicting cross-clamping intolerance is achieved by using analysis of P(A)-MR and MRA of the CoW in combination.
颈动脉内膜切除术（CEA）在降低有症状的严重颈动脉狭窄患者的中风风险方面是安全有效的。术前了解交叉钳夹（CC）不耐受情况可能会降低并发症发生率。本研究的目的是评估磁共振血管造影（MRA）和磁共振血管造影灌注（P-MR）在确定CEA期间CC不耐受风险方面的实用性。
将40例CEA术后出现CC不耐受的患者纳入第一组，15例CC耐受的患者纳入第二组。所有患者均接受了Willis环（CoW）的MRA、使用或不使用乙酰唑胺的P-MR；术后进行P（A）-MR。
第一组3例（7.5%）患者的MRA中CoW正常，第二组8例（53%）患者的CoW正常。我们发现第一组所有患者以及第二组40%的患者存在P-MR异常。使用计算得出的0.322的截断点，患者被分类为CC耐受，敏感性为100%，或CC不耐受，特异性为95%。单独评估P-MR或MRA后，假阴性结果的百分比显著增加。
通过联合使用P（A）-MR和CoW的MRA分析，在预测交叉钳夹不耐受方面具有最高价值。
