Stanton P E, McClusky D A, Lamis P A
Surgery. 1978 Dec;84(6):793-802.
Although kinking of the internal carotid artery has been recognized for many years, the surgical significance of this lesion has remained controversial. The present study was designed to identify hemodynamic significance of kinking of the internal carotid artery using a positional testing technique with preoperative and postoperative noninvasive data that were correlated with intraoperative electromagnetic flow measurements to establish operative criteria. A fluid-filled oculoplethysmograph (OPG) was used to assess carotid artery flow in 26 patients with cerebral ischemic symptoms who had angiographic documentation of kinking of the internal carotid artery. OPG testing was done with the patient's head positioned first in the neutral, then in the right and left rotations, and then in extension-flexion positions. Sixteen patients underwent angioplasty. At operation electromagnetic flow measurements of the internal carotid artery were determined in these 16 patients with similar positional maneuvers. A reduction of flow from 30% to 80% was found on positional testing during operation in 14 of these 16, and all 14 of these patients also had abnormal preoperative OPG testing. After angioplasty, effects of position on internal carotid artery flow were eliminated, as proved by electromagnetic flowmeter measurements and by follow-up OPG studies in all 14 patients. The other two patients who had been subjected to surgical correction had no positional effects as documented by electromagnetic flowmeter testing. A high correlation between noninvasive data and operative flow measurements suggests that positional OPG testing is helpful in identifying hemodynamically significant kinking. Symptomatic patients with kinking of the internal carotid artery and abnormal OPG testing may be candidates for corrective surgery.
尽管颈内动脉扭结已被认识多年，但该病变的手术意义仍存在争议。本研究旨在通过一种体位测试技术，利用术前和术后的无创数据，并将其与术中电磁血流测量结果相关联，以确定颈内动脉扭结的血流动力学意义，从而建立手术标准。使用充液式眼体积描记仪（OPG）对26例有脑缺血症状且血管造影证实有颈内动脉扭结的患者进行颈动脉血流评估。OPG测试时，患者头部先处于中立位，然后分别向左右旋转，再处于屈伸位。16例患者接受了血管成形术。在手术中，对这16例患者进行了类似体位操作下的颈内动脉电磁血流测量。在这16例患者中，有14例在手术中的体位测试时血流减少了30%至80%，并且这14例患者术前OPG测试均异常。血管成形术后，通过电磁流量计测量以及对所有14例患者的随访OPG研究证明，体位对颈内动脉血流的影响已消除。另外2例接受手术矫正的患者，电磁流量计测试未显示有体位影响。无创数据与手术血流测量结果之间的高度相关性表明，体位OPG测试有助于识别具有血流动力学意义的扭结。有颈内动脉扭结且OPG测试异常的有症状患者可能是矫正手术的候选者。
