血管超声在颈动脉内膜切除术前风险评估中的价值

摘要

Objective To investigate the role of vascular ultrasonography in presurgical risk assessment of carotid endarterectomy (CEA).Methods A total of 562 patients with severe (70-99％) stenosis of carotid artery underwent CEA at Xuanwu Hospital from January 2013 to December 2015 and were enrolled into this retrospective study.Before CEA,the patient's vascular structures on surgical side and intracranial-external arterial hemodynamics were evaluated by the carotid color Doppler flow imaging (CDFI),transcranial color coded sonography (TCCS) and/or transcranial Doppler (TCD) at Department of Vascular Ultrasonography.The factors related to postoperative (within 30 days) complications,including hyperperfusion,newly developed cerebral infarction and hemorrhage,were analyzed.Results The overall rate of postoperative complications including hyperperfusion (n =42),newly developed cerebral infarction (n =23) and hemorrhage (n =7) was 10.7％ (60/562 cases).Assessed by multivariate logistic analysis,closed anterior and posterior communicating arteries (OR =7.02,95％ CI:1.97-24.94,P =0.003) 、closed anterior communicating artery (OR =4.23,95％ CI:1.14-15.74,P =0.032),peak systolic velocity of the middle cerebral artery less than 60 cm/s (OR =5.49,95％ CI:2.99-10.10,P ＜ 0.0001),at least 60 years of age (OR =5.29,95％ CI:2.14-13.05,P ＜ 0.0001),common carotid artery bifurcation higher than the level of C2 (OR =3.29,95％ CI:1.01-10.97,P =0.049),severe stenosis or occlusion of contralateral carotid artery were identified to be independent risk factors for postoperative complications within 30 days.Conclusion Comprehensive presurgical evaluation of vascular structures on the surgical side and hemodynamics by CDFI,TCCS,and/or TCD would help select patient candidates suitable for CEA and prevent postsurgical complications.%目的 探讨血管超声在颈动脉内膜切除术(CEA)前风险评估中的应用价值.方法 回顾性纳入2013年1月至2015年12月在首都医科大学宣武医院行CEA的重度(70％～99％)颈动脉狭窄患者562例.所有患者术前于血管超声诊断科采用颈动脉彩色多普勒超声(CDFI)、经颅彩色多普勒超声(TCCS)和(或)经颅多普勒超声(TCD),对术侧血管结构及颅内-外动脉血流动力学进行评估.分析CEA术后30 d内发生过度灌注综合征、新发脑梗死及脑出血并发症的相关影响因素.结果 562例患者中,CEA术后30 d内共60例(10.7％)出现终点事件,其中过度灌注综合征42例,新发脑梗死23例,脑出血7例.多因素Logistic回归分析显示,前、后交通动脉均未开放(OR=7.02,95％ CI:1.97 ～ 24.94,P=0.003)、前交通动脉未开放(OR=4.23,95％ CI:1.14 ～ 15.74,P=0.032)、术侧大脑中动脉收缩期峰值流速＜60 cm/s(OR=5.49,95％ CI:2.99 ～10.10,P＜0.0001)、年龄≥60岁(OR=5.29,95％ CI:2.14 ～ 13.05,P＜0.0001)、颈总动脉分叉位置高于C2水平(OR=3.29,95％ CI:1.01 ～ 10.97,P=0.049)、合并对侧颈动脉重度狭窄或闭塞(OR=2.03,95％ CI:1.01～4.17,P=0.049)是CEA术后并发症的独立危险因素.结论 CEA术前联合应用颈动脉CDFI、TCCS和(或)TCD综合评估术侧血管病变局部结构和血流动力学,有助于选择适宜手术的患者,预防术后并发症的发生.