Lagneau P, Baujat B, Anidjar S, Borie H, Kovarsky S, Decamps Le Chevoir J, Coppe G
Department of Vascular Surgery, Hopital Saint Michel, Paris, France.
Int Angiol. 1998 Sep;17(3):168-70.
Transcranial Doppler is often proposed for evaluation of the Circle of Willis prior to carotid endarterectomy. The purpose of this study was to evaluate preoperative TCD before carotid surgery.
This is a retrospective report of 137 carotid endarterectomies performed under regional anesthesia operated between January 1992 on June 1996. All patients have a tight stenosis between 70% on 99%, and 49% were symptomatic. Forty-three patients of the 132 had a controlateral hemodynamically significant carotid stenosis with none occlusion. The TCD examinations were all performed with ADMS Doppler Spectradop with 3-MHz and 2-MHz probes. Clinical evaluation during cross-clamping was compared to the preoperative TCD. In 14% of the patients, the TCD could not be performed because there are not temporal bone windows.
When the patients could be tested the positive predictive value of the TCD was 18% and the sensitivity was 33%. The negative predictive value was 94%. 8% of the patients were shunted. TCD had numerous difficulties. The most common is the lack of the temporal bone window (40% of the patients). The compression test is often difficult when the lesion is calcareous. Preoperative TCD is not according to our results, a reliable enough examination to modify operative strategy during carotid surgery. When coupled with arteriography it is a good way to study cerebral hemoynamics.
Regional anesthesia with local supplication remains the method of choice to select those patients who require a shunt during carotid surgery. It can be used routinely and it is less complex than the various methods.
在颈动脉内膜切除术之前，经颅多普勒检查常被用于评估 Willis 环。本研究的目的是评估颈动脉手术前的术前经颅多普勒检查（TCD）。
这是一项对 1992 年 1 月至 1996 年 6 月间在区域麻醉下进行的 137 例颈动脉内膜切除术的回顾性报告。所有患者均有 70%至 99%的严重狭窄，其中 49%有症状。132 例患者中有 43 例对侧存在血流动力学显著的颈动脉狭窄但无闭塞。所有 TCD 检查均使用 ADMS 多普勒频谱仪及 3 兆赫和 2 兆赫探头进行。将夹闭期间的临床评估与术前 TCD 进行比较。14%的患者因没有颞骨窗而无法进行 TCD 检查。
当患者能够进行检测时，TCD 的阳性预测值为 18%，敏感性为 33%。阴性预测值为 94%。8%的患者接受了分流。TCD 存在诸多困难。最常见的是缺乏颞骨窗（40%的患者）。当病变为钙化时，压迫试验往往困难。根据我们的结果，术前 TCD 并非一项足够可靠的检查，不足以改变颈动脉手术期间的手术策略。当与动脉造影相结合时，它是研究脑血流动力学的一种好方法。
局部应用的区域麻醉仍然是选择那些在颈动脉手术期间需要分流的患者的首选方法。它可以常规使用，并且比各种其他方法更简单。
