Kjällman L, Blomstrand C, Holm J, Lundh T, Volkmann R
Department of Neurology, Sahlgrenska Hospital, Göteborg, Sweden.
Eur Neurol. 1995;35(5):259-63. doi: 10.1159/000117145.
Although it has now been established that surgery is the best way to treat patients with symptomatic tight carotid stenosis, the fact remains that perioperative risks are not negligible. Patients with significant contralateral stenosis and/or no collateral flow capacity through the anterior communicating artery are likely to be at higher risk during surgery. We examined a series of 52 patients pre- and postoperatively with transcranial Doppler (TCD) and compared the results to perioperative stump pressures. Our intention was to find out whether the results of the TCD examination of the circle of Willis could be correlated to the perioperative stump pressures, and whether TCD gives reliable information about the collateral flow. We found relatively high stump pressures in patients with potential function of any communicating artery, and in the group with no collateral function most patients had low stump pressures. We also found that preoperative flow velocity fall in the middle cerebral artery (MCA) on compression of the ipsilateral internal carotid artery correlated with perioperative stump-pressure indices. However, we were unable to predict stump pressures in individual patients by flow velocity measurements in the MCA preoperatively.
虽然现已确定手术是治疗有症状的严重颈动脉狭窄患者的最佳方法，但围手术期风险仍然不可忽视。对侧有严重狭窄和/或通过前交通动脉无侧支血流能力的患者在手术期间可能面临更高风险。我们对52例患者在术前和术后进行了经颅多普勒（TCD）检查，并将结果与围手术期残端压力进行比较。我们的目的是弄清楚 Willis 环的TCD检查结果是否与围手术期残端压力相关，以及TCD是否能提供有关侧支血流的可靠信息。我们发现，任何交通动脉有潜在功能的患者残端压力相对较高，而在无侧支功能组中，大多数患者残端压力较低。我们还发现，术前压迫同侧颈内动脉时大脑中动脉（MCA）血流速度下降与围手术期残端压力指数相关。然而，我们无法通过术前MCA血流速度测量来预测个体患者的残端压力。
