Predictors of Cerebral Reperfusion Injury After Carotid Stenting: the Role of Transcranial Color-Coded Doppler Ultrasonography

被引：21

作者：

Kablak-Ziembicka, Anna ^{[1
]}

Przewlocki, Tadeusz ^{[1
]}

Pieniazek, Piotr ^{[1
]}

Musialek, Piotr ^{[1
]}

Tekieli, Lukasz ^{[1
]}

Rosfawiecka, Agnieszka ^{[1
]}

Motyl, Rafal ^{[3
]}

Zmudka, Krzysztof ^{[2
]}

Tracz, Wieslawa ^{[1
]}

Podolec, Piotr ^{[1
]}

机构：

[1] Jagiellonian Univ, Sch Med, John Paul II Hosp, Dept Cardiac & Vasc Dis, PL-31202 Krakow, Poland

[2] Jagiellonian Univ, Sch Med, John Paul II Hosp, Dept Hemodynam & Angiocardiog, PL-31202 Krakow, Poland

[3] John Paul 2 Hosp, Ctr Diag Lung & Heart Dis, Krakow, Poland

来源：

JOURNAL OF ENDOVASCULAR THERAPY | 2010年 / 17卷 / 04期

关键词：

carotid artery stenting; cerebral reperfusion injury; transcranial color-coded Doppler ultrasound; internal carotid artery; peak systolic velocity; peak systolic velocity ratio; middle cerebral artery; risk prediction; HYPERPERFUSION SYNDROME; ENDARTERECTOMY; ANGIOPLASTY; CIRCLE; WILLIS; FLOW; HEMODYNAMICS; PREVENTION; HEMORRHAGE; DISEASE;

D O I：

10.1583/09-2980.1

中图分类号：

R61 [外科手术学];

学科分类号：

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 4483) 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. J Endovasc Ther. 2010;17:556-563

引用

页码：556 / 563

页数：8

共 32 条

[11] PREDICTION OF INTRACEREBRAL HEMORRHAGE AFTER CAROTID ENDARTERECTOMY BY CLINICAL-CRITERIA AND INTRAOPERATIVE TRANSCRANIAL DOPPLER MONITORING - RESULTS OF 233 OPERATIONS [J].