Zbornikova V, Lassvik C, Alm A
Department of Neurology, University Hospital, Linköping, Sweden.
Acta Neurol Scand. 1998 Oct;98(4):248-53. doi: 10.1111/j.1600-0404.1998.tb07304.x.
The aim of this study was to make a prospective evaluation of the carotid arteries after thrombendarterectomy by combined clinical and duplex examination, to define an exact time of development of postoperative restenosis/occlusion and to relate early morphological changes to occurrences of new neurological events.
Sixty-four patients (66 operations), 48 men and 16 women, mean age of 63+/-8 (SD) years, with transient ischaemic attacks or minor stroke were examined clinically 1 day before and after the carotid surgery. All except 3 patients had stenosis > or =50%. Duplex scanning and periorbital Doppler were performed before aortic arch angiography, within 2 weeks after operation and thereafter at 3, 6 and 12 months.
10 patients experienced minor stroke and one major stroke after operation, in 5 patients connected with occlusion on the operated side, which differed (P<0.01) from 56 patients with open vessels in whom 6 ipsilateral minor strokes occurred. Four of 6 patients with minor stroke, in whom the operated vessels were open, recovered, whereas the neurological deficits were permanent in all 5 patients with occlusion (P<0.05). Duplex scanning confirmed 10 new occlusions and 2 high grade stenoses >75% postoperatively. Persisting morbidity was 11% and no mortality at 3 months' control. At 12 months' control, 1 patient had stroke related to preoperatively diagnosed occlusion on the non-operated side and 14 flow reducing lesions >75% (11 occlusions and 3 stenoses >75%) were found in 57 (24.6%) of examined vessels.
occlusion occurs in immediate postoperative period and seems to be a serious complication connected with significantly higher number of persistent neurological events than open vessels.
本研究旨在通过临床和双功超声检查对血栓内膜切除术后的颈动脉进行前瞻性评估，确定术后再狭窄/闭塞的确切发生时间，并将早期形态学变化与新的神经事件的发生相关联。
64例患者（66次手术），48例男性和16例女性，平均年龄63±8（标准差）岁，有短暂性脑缺血发作或轻度中风，在颈动脉手术前后1天进行临床检查。除3例患者外，所有患者狭窄程度均≥50%。在主动脉弓血管造影前、术后2周内以及此后3、6和12个月进行双功扫描和眶周多普勒检查。
10例患者术后发生轻度中风，1例发生重度中风，其中5例与手术侧闭塞有关，这与56例血管通畅的患者不同（P<0.01），后者发生了6例同侧轻度中风。6例轻度中风患者中，手术血管通畅的4例恢复，而所有5例闭塞患者的神经功能缺损均为永久性（P<0.05）。双功扫描证实术后有10例新的闭塞和2例>75%的高度狭窄。3个月复查时持续发病率为11%，无死亡病例。在12个月复查时，1例患者发生与术前诊断的非手术侧闭塞相关的中风，在57例（24.6%）检查血管中发现14处血流减少性病变>75%（11例闭塞和3例狭窄>75%）。
闭塞发生在术后即刻，似乎是一种严重并发症，与血管通畅的患者相比，持续性神经事件的数量明显更多。
