医学
经颅多普勒
超声科
多普勒效应
放射科
颈动脉支架置入术
心脏病学
颈动脉
内科学
颈动脉内膜切除术
天文
物理
作者
Anna Kabłak‐Ziembicka,Tadeusz Przewłocki,Piotr Pienia̧żek,Piotr Musiałek,Łukasz Tekieli,Agnieszka Rosławiecka,Rafał Motyl,Krzysztof Żmudka,Wiesława Tracz,Piotr Podolec
摘要
Purpose:To evaluate the possible role of transcranial color-coded Doppler ultrasonography (TCD) in predicting cerebral reperfusion injury (CRI) in patients undergoing carotid artery stenting (CAS) for internal carotid artery (ICA) stenosis. Methods:TCD was obtained in 210 patients (149 men; mean age 64.2±8.4 years, range 44–83) who underwent CAS for ICA stenosis averaging 86.7%±8.4%. Contralateral ICA occlusion or near occlusion (stenosis >90%) was present in 67 (31.9%) patients. TCD was performed before and 24 hours after CAS with assessment of peak systolic velocities (PSVs) in the ipsilateral middle cerebral artery (iMCA) and contralateral middle cerebral artery (cMCA). PSV ratios (PSVR) in the iMCA and cMCA were calculated from the PSVs before and after CAS. Results:CRI syndrome occurred in 3 (1.4%) patients (2 intracranial bleedings, 1 subarachnoid hemorrhage). The mean iMCA and cMCA PSVRs were 2.66±0.19 and 4.16±2.77, respectively, in CRI patients, while the PSVRs in CAS patients without neurological sequelae were 1.56±0.46 and 1.21±0.39, respectively (both p<0.001). The combination of iPSVR>2.4 and cPSVR>2.4 occurred in 4 patients with bilateral ICA disease; 3 (75%) of them developed CRI (100% sensitivity and 99% specificity for CRI prediction). The following independent CRI predictors were identified: combined iPSVR>2.4 and cPSVR>2.4 (RR 2.06, CI 1.89 to 2.24; p<0.001), high cMCA PSV after CAS (RR 1.23, CI 1.13 to 1.34; p<0.001), and contralateral ICA occlusion (RR 1.13, CI 1.03 to 1.23; p=0.007). Conclusion:TCD is an important tool in CRI risk evaluation. The combination of iPSVR>2.4 and cPSVR>2.4 is an independent CRI risk factor, along with contralateral ICA occlusion and high cMCA PSVs after CAS.
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