Ultrasound-guided central venous catheterization: efficacy of simultaneous perioperative ultrasonographic scanning for the presence of carotid plaques in the prevention of the perioperative development of ischemic stroke.

摘要

Carotid plaques are frequently seen in patients who have suffered from an episode of stroke. Conversely, the risk of. stroke is strongly correlated with the presence of carotid plaques [1]. Thrombus formed on atherosclerotic plaques, as well as the plaques themselves, may migrate and embolize the intracranial arteries, resulting in an artery-to-artery embolic cerebral infarction. Apart from cardiac and carotid artery surgery, in which the risk of stroke periop-eratively is well recognized [2], the incidence of stroke in the general surgical population is reported to be between 0.2 and 0.7% [3]. Approximately 40% of cases of stroke in this population were attributable to cardiogenic embolism associated with atrial fibrillation, followed by carotid arterial disease, which accounts for approximately 10% of perioperative cerebrovascular disease. In order to prevent the accidental release of thrombus formed on atheromatous plaques, as well as the the accidental release of plaque itself, blood pressure should be kept within the patient's normal range [3]. Additionally, hyperextension of the neck should be avoided because it can stretch the carotid artery, thereby causing intimal tears which can act as a nidus for thrombus formation [4].