Davies K N, Humphrey P R
Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
J Neurol Neurosurg Psychiatry. 1993 Sep;56(9):967-72. doi: 10.1136/jnnp.56.9.967.
After nearly 40 years, carotid endarterectomy has been shown to be of benefit to patients with symptomatic carotid territory ischaemia and greater than 70% stenosis of the relevant internal carotid artery. Cerebral angiography is performed before surgery and is not without risk. These risks must be added to those of surgery before recommending the procedure to patients. The study evaluated the local, systemic and neurological complications following digital subtraction angiography with selective catheterisation of the carotid arteries in 200 patients presenting to a cerebrovascular clinic for assessment of cerebral ischaemia. All patients had carotid ultrasound screening before angiography to screen out those with normal arteries or mild disease (less than 30% stenosis of symptomatic internal carotid artery). Complications occurred in 28 patients. There were six (3%) local, two (1%) systemic and 20 (10%) neurological complications. Seventeen neurological complications occurred within 24 hours and there were three late complications (24-72 hours). Neurological complications occurred more frequently when angiography was performed by a trainee rather than a consultant neuroradiologist (p < 0.01). The neurological complications were transient (resolved within 24 hours) in 10/200 (5%), reversible (resolved within seven days) in two (1%) and permanent in 8/200 (4%). Two patients died after a stroke and two other patients suffered a disabling stroke. At 24 hours post angiography the permanent (persisting beyond seven days) neurological complication rate was 2.5%. The incidence of total neurological complications and post angiographic strokes was higher in patients with greater than 90% stenosis of the symptomatic internal carotid artery (p < 0.001). The increased use of non-invasive Doppler duplex screening will reduced the absolute number of patients put at risk of angiography, yet the rate of post angiographic complications is likely to increase as patients with severe stenosis of the symptomatic internal carotid artery are probably most at risk of complications and have most to gain from carotid endarterectomy.
经过近40年的研究，已证实颈动脉内膜切除术对有症状的颈动脉供血区缺血且相关颈内动脉狭窄超过70%的患者有益。手术前需进行脑血管造影，而这并非毫无风险。在向患者推荐该手术之前，必须将这些风险与手术风险相加考虑。该研究评估了200名到脑血管诊所评估脑缺血的患者在进行数字减影血管造影及选择性颈动脉导管插入术后的局部、全身和神经并发症。所有患者在血管造影前均进行了颈动脉超声筛查，以排除动脉正常或疾病较轻（有症状的颈内动脉狭窄小于30%）的患者。28名患者出现了并发症。其中有6例（3%）局部并发症、2例（1%）全身并发症和20例（10%）神经并发症。17例神经并发症发生在24小时内，有3例晚期并发症（24 - 72小时）。当血管造影由实习医生而非神经放射科顾问进行时，神经并发症的发生频率更高（p < 0.01）。神经并发症中，10/200（5%）为短暂性（24小时内缓解），2例（1%）为可逆性（7天内缓解），8/200（4%）为永久性。2例患者在中风后死亡，另外2例患者发生了致残性中风。血管造影后24小时，永久性（持续超过7天）神经并发症发生率为2.5%。有症状的颈内动脉狭窄超过90%的患者，其总神经并发症和血管造影后中风的发生率更高（p < 0.001）。无创多普勒双功超声筛查使用的增加将减少面临血管造影风险的患者绝对数量，但随着有症状的颈内动脉严重狭窄的患者可能是并发症风险最高且从颈动脉内膜切除术中获益最大的人群，血管造影后并发症的发生率可能会增加。
