Gossetti B, Martinelli O, Guerricchio R, Irace L, Benedetti-Valentini F
2nd Chair of Vascular Surgery, La Sapienza University of Roma, Italy.
J Neuroimaging. 1997 Oct;7(4):213-6. doi: 10.1111/jon199774213.
From July 1991 to March 1995, 178 patients who underwent 198 carotid surgical repairs were investigated preoperatively, intraoperatively, and postoperatively by transcranial Doppler sonography (TCD). Preoperative TCD evaluation showed stenosis of the middle cerebral artery (MCA) in 4 patients (2.2%), siphon stenosis in 3 (1.6%), incomplete circle of Willis in 23 (12.9%), a decrease of mean blood flow velocity more than 70% of the basal value during digital common carotid compression in 31 (17.9%), and a critical reduction of vasomotor reactivity (no significant increase of mean blood flow velocity in the MCA during breath-holding test) in 34 (19.1%). Nine patients (5%) had surgery without preoperative angiography. In those patients the indication for surgery was based on color Doppler imaging and TCD investigations. Ninety surgical procedures were carried out under general anesthesia and 188 under locoregional anesthesia. In 37 surgeries (31.7%) a shunt was inserted. The use of a shunt was based on a decrease of mean blood flow velocity in the MCA below 50% of the basal value under general anesthesia or loss of consciousness combined with a decrease of mean blood flow velocity in the MCA higher than 70% of the basal value when locoregional anesthesia was employed. Intraoperative TCD monitoring showed a decrease of mean blood flow velocity in the MCA due to shunt malfunction in (8.3%) of 36 surgeries, turbulence of blood flow during declamping in 79 procedures (39.8%), and microembolic events in 10 patients (5%) that were related to one transient and one permanent neurological deficit. Another permanent deficit occurred in a patient without TCD signs. After surgery, TCD reliably detected an early asymptomatic occlusion of the carotid artery, hyperperfusion syndrome in 12 (6.0%), and an increase of vasomotor reactivity in 10 (29.4%) of 34 surgeries.
1991年7月至1995年3月，对178例接受198次颈动脉手术修复的患者在术前、术中和术后进行了经颅多普勒超声检查（TCD）。术前TCD评估显示，4例患者（2.2%）大脑中动脉（MCA）狭窄，3例（1.6%）虹吸部狭窄，23例（12.9%） Willis环不完整，31例（17.9%）在手指压迫颈总动脉时平均血流速度下降超过基础值的70%，34例（19.1%）血管运动反应性严重降低（屏气试验期间MCA平均血流速度无显著增加）。9例患者（5%）未进行术前血管造影就接受了手术。在这些患者中，手术指征基于彩色多普勒成像和TCD检查。90例手术在全身麻醉下进行，188例在局部麻醉下进行。37例手术（31.7%）中插入了分流管。分流管的使用基于全身麻醉下MCA平均血流速度下降至基础值的50%以下，或局部麻醉时意识丧失并伴有MCA平均血流速度下降超过基础值的70%。术中TCD监测显示，36例手术中有3例（8.3%）因分流管故障导致MCA平均血流速度下降，79例手术（占39.8%）在松开血管夹时出现血流紊乱，10例患者（5%）出现微栓塞事件，其中1例短暂性和1例永久性神经功能缺损与之相关。另1例永久性缺损发生在1例无TCD征象的患者中。术后，TCD可靠地检测到颈动脉早期无症状闭塞、12例（6.0%）出现高灌注综合征以及34例手术中有10例（29.4%）血管运动反应性增加。
