Ivey T D, Strandness E, Williams D B, Langlois Y, Misbach G A, Kruse A P
J Thorac Cardiovasc Surg. 1984 Feb;87(2):183-9.
During a 31 month period, 1,433 consecutive patients undergoing cardiac procedures were screened for carotid bruit. A total of 94 patients with carotid bruit were identified who had ultrasonic carotid duplex scans. Nine patients had a history of transient ischemic attack, carotid bruit, and reduction in internal carotid artery diameter by greater than or equal to 50% according to ultrasonic carotid duplex scanning. All nine patients underwent carotid angiography followed by thromboendarterectomy prior to or simultaneous with cardiopulmonary bypass. There was one neurological complication leading to death in this subset. Sixteen patients with asymptomatic carotid bruit had ultrasonic carotid duplex scanning revealing an internal carotid artery lesion of greater than or equal to 50% but did not undergo arteriography or thromboendarterectomy prior to the cardiac procedure. Perfusion pressure was maintained at greater than or equal to 70 mm Hg during bypass. There were no focal neurological events in this subset. Sixty-six patients with internal carotid artery stenosis of less than 50% diameter reduction and asymptomatic bruits had no further work-up or modification in perfusion technique, and there were no focal neurological events in this group. Thus there were no focal neurological events in any of the 82 patients with asymptomatic carotid bruit. An additional group of three patients with a previous stroke and internal carotid artery occlusion by ultrasonic carotid duplex scanning had transient exacerbation of neurological symptoms after cardiopulmonary bypass. The remaining 1,339 patients without carotid bruit had nine (0.7%) focal neurological events postoperatively. We believe that asymptomatic patients with or without hemodynamically significant stenosis can safely undergo cardiopulmonary bypass procedures without carotid thromboendarterectomy. Patients with asymptomatic bruits can be safely screened with ultrasonic carotid duplex scanning and do not require arteriography prior to cardiopulmonary bypass.
在31个月的时间里，对1433例连续接受心脏手术的患者进行了颈动脉杂音筛查。共识别出94例有颈动脉杂音的患者，并对其进行了颈动脉超声双功扫描。9例患者有短暂性脑缺血发作史、颈动脉杂音，且根据颈动脉超声双功扫描显示颈内动脉直径缩小大于或等于50%。所有9例患者在体外循环之前或同时接受了颈动脉血管造影，随后进行了血栓内膜切除术。该亚组中有1例神经并发症导致死亡。16例无症状颈动脉杂音患者经颈动脉超声双功扫描显示颈内动脉病变大于或等于50%，但在心脏手术前未进行血管造影或血栓内膜切除术。体外循环期间灌注压力维持在大于或等于70 mmHg。该亚组中无局灶性神经事件发生。66例颈内动脉狭窄直径缩小小于50%且无症状杂音的患者未进行进一步检查或改变灌注技术，该组中也无局灶性神经事件发生。因此，82例无症状颈动脉杂音患者中均无局灶性神经事件发生。另外一组3例曾有中风且经颈动脉超声双功扫描显示颈内动脉闭塞的患者在体外循环后出现神经症状短暂加重。其余1339例无颈动脉杂音的患者术后有9例（0.7%）发生局灶性神经事件。我们认为，有无血流动力学显著狭窄的无症状患者在不进行颈动脉血栓内膜切除术的情况下可安全地接受体外循环手术。无症状杂音患者可通过颈动脉超声双功扫描进行安全筛查，在体外循环前不需要进行血管造影。
