Rodino W, Panetta T F, Burack J H, Bryan D H, Williams R F
Division of Vascular Surgery, State University of New York Health Science Center at Brooklyn, USA.
J Vasc Surg. 1996 Dec;24(6):1017-21. doi: 10.1016/s0741-5214(96)70047-2.
Neurologic injury is one of the most devastating complications of combined carotid and cardiac procedures. Although the cause of the deficit is usually embolic, the exact cause is often not apparent at the time of surgery. We present a complex case of combined carotid endarterectomy, innominate artery reconstruction, and coronary artery bypass procedures in which intraoperative monitoring with somatosensory evoked potentials and transcranial Doppler ultrasonography combined with postoperative acetazolamide single photon emission computed tomographic scans was used to correlate intraoperative events with cerebral activity and functional results. Although computed tomographic scan, magnetic resonance imaging, and clinical evaluation were negative for any evidence of stroke, the patient exhibited subtle postoperative changes in neuropsychologic function. These changes were correlated with intraoperative microemboli detected by transcranial Doppler monitoring, and postoperative acetazolamide single photon emission computed tomographic scanning, which revealed bilateral cortical defects.
神经损伤是颈动脉和心脏联合手术最具破坏性的并发症之一。虽然神经功能缺损的原因通常是栓塞性的，但确切病因在手术时往往并不明显。我们报告了一例复杂的颈动脉内膜切除术、无名动脉重建术和冠状动脉搭桥术病例，术中采用体感诱发电位和经颅多普勒超声监测，并结合术后乙酰唑胺单光子发射计算机断层扫描，以关联术中事件与脑活动及功能结果。尽管计算机断层扫描、磁共振成像和临床评估均未发现任何中风迹象，但患者术后神经心理功能出现了细微变化。这些变化与经颅多普勒监测检测到的术中微栓子以及术后乙酰唑胺单光子发射计算机断层扫描结果相关，后者显示双侧皮质缺损。
