Charloux Anne, Matau Cézar, Jégu Jérémie, Rouyer Olivier, Falcoz Pierre-Emmanuel, Quoix Elisabeth
Department of Physiology and Lung Function Testing, University Hospital of Strasbourg, Strasbourg, France.
EA 3072, FMTS, Strasbourg University, Strasbourg, France.
J Thorac Dis. 2020 Nov;12(11):6743-6751. doi: 10.21037/jtd-20-1117.
Postoperative stroke is a rare complication after lung cancer surgery but has a high mortality rate. No strategy has been recommended to detect carotid artery disease preoperatively in lung cancer patients. The main objective of this study was to evaluate whether a routine carotid duplex ultrasound (DUS) altered the preoperative management of these patients.
We performed a single-centre, retrospective study of all patients referred for lung cancer resection over a two-year period and reviewed the available carotid DUS results. We quantified the number of carotid artery disease diagnosis, the severity of the disease according to DUS results, and the number of treatments initiated preoperatively. We examined relationships between cardiovascular history and preoperative carotid artery disease diagnosis.
Among the 398 consecutive lung surgery patients, 6% had a preoperative history of stroke or transient ischemic attack, and one developed a postoperative stroke, of cardioembolic origin. Three hundred and seven patients (77%) had preoperative carotid DUS. Carotid DUS results elicited anti-platelet therapy initiation or endarterectomy before lung resection in 7 out of these 307 patients (2.3%). One hundred and seventy-one carotid DUS were retrospectively reviewed by an expert, who diagnosed carotid stenosis >50% and occlusion in 2.3% and 1.2% of patients, respectively. Abnormal carotid DUS was associated with history of lower extremity artery disease (P<0.001), diabetes mellitus (P<0.05) and dyslipidemia (P<0.05).
This retrospective observational study showed that routine preoperative carotid DUS led to few carotid stenosis detection and few perioperative management alterations. Carotid artery disease diagnosis was associated with cardiovascular history and risk factors. Future studies should examine how to select patients who will benefit from a preoperative carotid DUS.
术后中风是肺癌手术后一种罕见的并发症，但死亡率很高。目前尚无推荐的策略用于在肺癌患者术前检测颈动脉疾病。本研究的主要目的是评估常规颈动脉双功超声（DUS）是否会改变这些患者的术前管理。
我们对两年内所有转诊接受肺癌切除术的患者进行了一项单中心回顾性研究，并回顾了现有的颈动脉DUS结果。我们对颈动脉疾病诊断的数量、根据DUS结果确定的疾病严重程度以及术前开始的治疗数量进行了量化。我们研究了心血管病史与术前颈动脉疾病诊断之间的关系。
在398例连续接受肺手术的患者中，6%有中风或短暂性脑缺血发作的术前病史，1例发生了心源性栓塞性起源的术后中风。307例患者（77%）术前行颈动脉DUS检查。在这307例患者中，有7例（2.3%）的颈动脉DUS结果导致在肺切除术前开始抗血小板治疗或进行动脉内膜切除术。一名专家对171例颈动脉DUS进行了回顾性评估，分别诊断出2.3%和1.2%的患者存在颈动脉狭窄>50%和闭塞。颈动脉DUS异常与下肢动脉疾病史（P<0.001）、糖尿病（P<0.05）和血脂异常（P<0.05）有关。
这项回顾性观察研究表明，常规术前颈动脉DUS检测到的颈动脉狭窄很少，围手术期管理改变也很少。颈动脉疾病诊断与心血管病史和危险因素有关。未来的研究应探讨如何选择能从术前颈动脉DUS中获益的患者。
