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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Cerebral Neuromonitoring during Carotid Endarterectomy and Impact of Contralateral Internal Carotid Occlusion
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Cerebral Neuromonitoring during Carotid Endarterectomy and Impact of Contralateral Internal Carotid Occlusion

机译：颈动脉内切除术期间的脑神经监测及对侧内颈动脉闭塞的影响

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Background: The aim of this study was to identify the reliability of carotid artery stump pressure (SP) in predicting the neurologic changes and correlation with contralateral internal carotid artery (ICA) occlusion in patients undergoing eversion carotid endarterectomy (CEA). The optimal method for monitoring cerebral perfusion during CEA, performed under either local or general anesthesia, is still controversial. Methods: We prospectively analyzed 118 consecutive patients undergoing eversion CEA under local anesthesia. We had 78 symptomatic (66%) and 40 asymptomatic patients (33.9%). Selective shunting was performed in patients who developed neurologic changes after carotid clamping regardless of SP. Correlation of preoperative symptom status, a degree of stenosis, status of contralateral ICA, arterial blood pressure, SP value, and the intraoperative need for shunting due to neurologic changes was evaluated for both groups: shunted and nonshunted. Results: Selective shunting was performed in 12 patients (10%). There was no significant difference among the groups regarding the demographic characteristics. Mean carotid clamping time was 14.57 minutes. We had no perioperative mortality, stroke, or myocardial infarction. None of the patients required conversion to general anesthesia. We found a mean SP of 31 mm Hg as a reliable threshold for shunting (P .001; sensitivity 92.3%; specificity 91.3%). Contralateral carotid occlusion was correlated with the significantly lower SP (27 +/- 13 mm Hg; P = .001) and the higher need for shunt (50%). Conclusions: SP measurement is a reliable and simple method for monitoring the collateral cerebral perfusion and can predict the need for shunting during CEA. Patients with the contralateral ICA occlusion showed significantly lower SP, although it did not have impact on the outcome. (C) 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.
机译：背景：本研究的目的是确定颈动脉残端压力（SP）在预测接受外翻性颈动脉内膜切除术（CEA）患者的神经系统变化以及与对侧颈内动脉（ICA）闭塞的相关性方面的可靠性。在局部或全身麻醉下，CEA期间监测脑灌注的最佳方法仍有争议。方法：我们前瞻性分析了118例在局麻下进行外翻手术的患者。我们有78例有症状（66%）和40例无症状（33.9%）。对颈动脉钳夹后出现神经系统改变的患者进行选择性分流，而不考虑SP。对两组患者术前症状状态、狭窄程度、对侧ICA状态、动脉血压、SP值以及术中因神经系统改变而需要分流的相关性进行评估：分流组和非分流组。结果：12例（10%）进行了选择性分流。在人口统计学特征方面，各组之间没有显著差异。平均颈动脉钳夹时间为14.57分钟。我们没有围手术期死亡率、中风或心肌梗死。没有一名患者需要转为全身麻醉。我们发现平均SP为31毫米汞柱是分流的可靠阈值（P；001；敏感性92.3%；特异性91.3%）。对侧颈动脉闭塞与显著较低的SP（27+/-13毫米汞柱；P=.001）和较高的分流需求（50%）相关。结论：SP测量是监测侧支脑灌注的一种可靠、简单的方法，可以预测CEA期间是否需要分流。对侧ICA闭塞患者的SP显著降低，但对预后无影响。（C） 2018年全国中风协会。爱思唯尔公司出版。版权所有。

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