Gaunt M E, Brown L, Hartshorne T, Bell P R, Naylor A R
Department of Surgery, Leicester Royal Infirmary, U.K.
Eur J Vasc Endovasc Surg. 1996 Jan;11(1):78-82. doi: 10.1016/s1078-5884(96)80139-0.
To investigate whether unstable carotid plaque characteristics, as determined by preoperative colour Duplex ultrasonography (CDU) and postoperative histological examination, were associated with particulate embolisation, detected by transcranial Doppler (TCD), during the initial dissection of the carotid bifurcation during carotid endarterectomy(CEA).
A prospective, consecutive study was undertaken of 50 patients undergoing carotid endarterectomy(CEA).
Leicester Royal Infirmary, Leicester, U.K.
Carotid plaques were assessed preoperatively using CDU. Intraoperative TCD monitoring of the ipsilateral middle cerebral artery was performed using a Scimed 2MHz TCD. Carotid plaques removed at operation were processed histologically and multiple sections assessed microscopically.
Plaque composition was classified ultrasonically and histologically according to the Gray-Weale classification and plaque surface characteristics were graded according to a five point classification. TCD detected emboli were identified and counted during the initial dissection of the artery.
Particulate embolisation occurred in nine patients. Histologically, embolisation was associated with ulcerated plaque in three cases and ulcerated plaque with associated thrombus in six cases (p = 0.0005). However, the ability of CDU to positively predict embolisation based on the correct identification of an unstable plaque surface was only 25%.
Embolisation during dissection is strongly associated with ulcerated plaque with associated thrombus. CDU is unable to reliably identify these characteristics preoperatively. Intraoperative TCD monitoring can detect potentially harmful embolisation during this stage enabling surgical technique to be modified appropriately.
通过术前彩色双功超声检查（CDU）和术后组织学检查确定不稳定颈动脉斑块特征，研究其是否与颈动脉内膜切除术（CEA）期间颈动脉分叉初始解剖过程中经颅多普勒（TCD）检测到的微粒栓塞有关。
对50例行颈动脉内膜切除术（CEA）的患者进行了一项前瞻性、连续性研究。
英国莱斯特莱斯特皇家医院
术前使用CDU评估颈动脉斑块。术中使用Scimed 2MHz TCD对同侧大脑中动脉进行TCD监测。手术中切除的颈动脉斑块进行组织学处理，并对多个切片进行显微镜评估。
根据Gray-Weale分类对斑块成分进行超声和组织学分类，并根据五点分类法对斑块表面特征进行分级。在动脉初始解剖过程中识别并计数TCD检测到的栓子。
9例患者发生微粒栓塞。组织学上，3例栓塞与溃疡斑块有关，6例与伴有血栓的溃疡斑块有关（p = 0.0005）。然而，CDU基于正确识别不稳定斑块表面来阳性预测栓塞的能力仅为25%。
解剖过程中的栓塞与伴有血栓的溃疡斑块密切相关。CDU术前无法可靠地识别这些特征。术中TCD监测可在此阶段检测到潜在有害的栓塞，从而能够适当修改手术技术。
