Walden R, L'Italien G, Megerman J, Bouchier-Hayes D, Hanel K, Maloney R, Abbott W
Surgery. 1980 Jul;88(1):162-7.
Attempts to noninvasively estimate the significance of carotid arterial stenoses have resulted in a recent technological explosion. Ocular pulse wave timing [oculoplethysmography (OPG) pulse delay] has been strongly promulgated but also criticized on theoretical grounds and for lack of physiologic validation. Audiofrequency analysis of carotid bruits (carotid phonoangiography CPA) has been combined with OPG allegedly to improve accuracy. To evaluate these methods in a controlled model, we studied the effects of graded unilateral stenoses in the canine carotid artery on physiological parameters and associated OPG and CPA recordings. Arterial compliance was calculated from simultaneous diameter and pressure recordings distal to the stenosis. OPG time delay correlated directly with reductions in flow and pressure and with increasing arterial compliance (P less than 0.01). Thus, the delay is caused at least partially by a decreased pulse wave velocity, resulting from the increased compliance distal to stenoses associated with a significant pressure gradient. OPG is most discriminating for stenoses of higher grades. Because bruits arise from flow disturbances that occur even with moderate degrees of stenosis, CPA provides diagnostic information before profound flow reduction occurs. This study illustrates the value of complementary methods for analyzing complex hemodynamic phenomena and provides evidence to support use of the pulse delay concept to diagnose arterial disease.
非侵入性评估颈动脉狭窄严重程度的尝试引发了近期的技术爆炸。眼脉搏波定时[眼体积描记法（OPG）脉搏延迟]受到大力推广，但也因理论依据不足和缺乏生理学验证而受到批评。颈动脉杂音的音频分析（颈动脉血管音描记术CPA）据称已与OPG相结合以提高准确性。为了在一个可控模型中评估这些方法，我们研究了犬颈动脉分级单侧狭窄对生理参数以及相关OPG和CPA记录的影响。根据狭窄远端同时记录的直径和压力计算动脉顺应性。OPG时间延迟与血流和压力的降低以及动脉顺应性的增加直接相关（P小于0.01）。因此，这种延迟至少部分是由脉搏波速度降低引起的，这是由于与显著压力梯度相关的狭窄远端顺应性增加所致。OPG对较高等级的狭窄最具鉴别力。由于杂音是由即使中度狭窄也会出现的血流紊乱引起的，所以CPA在血流大幅减少之前就能提供诊断信息。这项研究说明了互补方法在分析复杂血流动力学现象中的价值，并为支持使用脉搏延迟概念诊断动脉疾病提供了证据。
