Dykes J R, Bergamini T M, Lipski D A, Fulton R L, Garrison R N
Department of Surgery, Department of Veterans Affairs Medical Center and University of Louisville, Kentucky 40202, USA.
Am Surg. 1997 Jan;63(1):50-4.
To evaluate the effect of intraoperative duplex scanning (IDS) on the incidence of perioperative and postoperative strokes as well as residual and recurrent stenosis, we reviewed 141 patients who underwent 152 consecutive carotid endarterectomies (CEAs) between July, 1990 and June, 1995. Follow-up of 129 cases, with a mean follow-up of two years, revealed no perioperative deaths and three strokes for a combined perioperative stroke-death rate of 2.3 per cent. In 50% (64 of 129) of the CEAs, intraoperative duplex scans were obtained based on the attending surgeon's preference. We noted that the incidence of residual stenosis (>50% stenosis on the first duplex after CEA) was significantly lower in those undergoing IDS (3/64) versus those without IDS (13/65) (P < 0.05; risk ratio 0.31; 95% confidence interval 0.11, 0.91). IDS resulted in a modification of the internal carotid reconstruction in 9 per cent (6 of 64) of the cases with no resulting postoperative strokes or residual/recurrent stenosis. There was no significant difference in the frequency of recurrent stenosis (>50% stenosis after a normal duplex) in the two groups (3 of 64 with vs 2 of 65 without). Of patients not undergoing intraoperative scanning, four underwent redo CEA for symptomatic residual stenosis due to a retained intimal flap in the internal carotid artery. There were three strokes observed within 30 days of the initial CEA, all of which occurred in patients who did not undergo IDS at their initial operation. We conclude that IDS can identify technical defects following internal carotid reconstruction, thereby reducing the incidence of both residual stenosis and postoperative morbidity in patients undergoing CEA.
为评估术中双功扫描（IDS）对围手术期和术后中风发生率以及残余和复发性狭窄的影响，我们回顾了1990年7月至1995年6月期间连续接受152例颈动脉内膜切除术（CEA）的141例患者。对129例患者进行随访，平均随访两年，结果显示无围手术期死亡，3例中风，围手术期中风-死亡率为2.3%。在50%（129例中的64例）的CEA手术中，根据主刀医生的偏好进行了术中双功扫描。我们注意到，接受IDS的患者中残余狭窄（CEA术后首次双功扫描显示狭窄>50%）的发生率（3/64）显著低于未接受IDS的患者（13/65）（P<0.05；风险比0.31；95%置信区间0.11，0.91）。IDS导致9%（64例中的6例）的病例对颈内动脉重建进行了调整，术后未发生中风或残余/复发性狭窄。两组复发性狭窄（双功扫描正常后狭窄>50%）的频率无显著差异（接受IDS的64例中有3例，未接受IDS的65例中有2例）。未进行术中扫描的患者中，有4例因颈内动脉内膜瓣残留导致有症状的残余狭窄而接受了再次CEA手术。在初次CEA术后30天内观察到3例中风，均发生在初次手术未接受IDS的患者中。我们得出结论，IDS可以识别颈内动脉重建后的技术缺陷，从而降低接受CEA手术患者的残余狭窄发生率和术后发病率。
