颈动脉支架成形术中经颅多普勒超声检测微栓子信号

目的:观察颈动脉支架成形术中经颅多普勒超声(TCD)检测到的微栓子信号(MES)数量与手术各操作步骤的相关性。方法:对15例严重颈动脉狭窄患者在颈动脉支架成形术中采用TCD进行全程动态MES监测。将整个操作过程分为导丝和脑保护滤网通过狭窄部位、球囊预扩张、支架置入、球囊后扩张、回收脑保护滤网5个阶段,观察手术侧大脑中动脉的MES数量与手术各操作步骤的相关性。结果:15例患者术中各操作阶段均可产生MES。MES数量67~309(中位数173),其中支架置入是微栓子最易脱落的阶段,占MES总数量的54.2%。减少操作步骤可明显减少MES的数量。结论:TCD可以全程动态监测颈动脉支架成形术各个阶段的MES数量,指导手术安全进行。

Monitoring of microembolic signals using transcranial Doppler in Carotid Angioplasty and Stenting

Objective: This study was designed to monitor the microembolic signals using transcranial Doppler (TCD) during filter-protected carotid angioplasty and stenting(CAS) and to observe the relationship between the amount of MES and the different procedure phases of CAS. Methods: Fifteen patients who successfully underwent filter-protected CAS and TCD monitoring were enrolled. The MES in the ipsilateral middle cerebral artery was real-time monitored by TCD during whole operation. The procedure was divided into five phases: filter device or wire passage of the stenosis, predilation, stent deployment, postdilation, and retrieval of the protection device. For each phase of the procedure, the amount of MES was detected and registered using TCD. Results: The numerous microembolic signals were detected during CAS in all patients. The numbers of MES are different during the various steps of the CAS procedure. The stent deployment was the procedure with significantly increased MES counts which accounted for 54.2 % of the total. Less procedure led to significantly lower MES counts during CAS. Conclusion: TCD can effectively detect the number of MES in various steps of the procedure during filter-protected CAS and help the surgeon to make the operation safer.