前、后交通动脉开放性评估对颈动脉内膜剥脱术中选择性分流的预测价值

 目的 探讨经颅多普勒超声(TCD)评估前、后交通动脉开放性对颈动脉内膜剥脱术(CEA)中选择性分流的预测价值。方法 对拟行CEA手术的25例患者行TCD检测，术前通过压颈试验对前交通动脉（ACOA）及术侧后交通动脉(PCOA)的开放性进行定性评估，根据交通动脉开放情况预测术中是否需要转流。ACOA或术侧PCOA不开放者列入术中需转流患者；前、后交通动脉均开放者列入术中非转流患者。术中应用TCD于颈动脉夹闭前后即刻记录同侧大脑中动脉（MCA）的血流动力学参数，根据MCA在夹闭前后血流速度下降的程度选择是否行转流术，将术前TCD预测转流的结果与术中行转流术的结果进行对比分析。结果 （1）25例行CEA手术患者，术前TCD评估非转流患者18例（72％），转流患者7例（28％）；（2）术中行转流术者6例（24％），非转流者19例（76％）；（3）与手术结果比较，术前TCD评估预测术中转流术的准确度为88％，敏感度为83％。结论 术前通过TCD对前、后交通动脉开放性进行评估，对CEA术中选择性分流具有预测价值。

Predictive Value of ACoA and PCoA Patent for Selective Shunt of Carotid Endarterectomy

Objective To evaluate the predictive value of anterior communicating artery(ACoA)and posterior communicating artery(PCoA)patent for the selective shunt of carotid endarterectomy(CEA) by using transcranial doppler(TCD).Methods TCD was performed in 25 patients before surgery.The open of ACoA and operation side PCoA were evaluated by carotid compression test,and then decided whether shunt was needed.The patients whose ACoA or operation side PCoA was not open at all or not fully open were sorted into shunt group,and the patients whose ACoA and PCoA were both open were categorized into non-shunt group.The blood flow parameters of middle cerebral artery(MCA) were determined by TCD just before and after carotid artery occlusion during the operation,and the changes of the velocity of MCA were applied as a basis for the perform of shunt.The results before and during operation were compared.Results(1)Among the 25 cases,18 patients were sorted into non-shunt group before operation(72%);and 7 patients were sorted into shunt group(28%).(2) Six patients took shunt during operation(24%);and 19 patients did not(76%).(3) Compared with the operation result,the accuracy and sensitivity of pre-operation TCD′s prediction were 88% and 83%,respectively.Conclusion TCD has predictive value for the selective shunt of CEA through evaluation on the patent of ACoA and PCoA.