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Timing of clinically significant microembolism after carotid endarterectomy
被引:17
作者:
Abbott, A. L.
Levi, C. R.
Stork, J. L.
Donnan, G. A.
Chambers, B. R.
机构:
[1] Natl Stroke Res Inst, Heidelberg, Vic 3081, Australia
[2] Univ Melbourne, Parkville, Vic 3052, Australia
[3] John Hunter Hosp, Dept Neurosci, Newcastle, NSW, Australia
[4] Austin Hlth, Neurol Dept, Melbourne, Vic, Australia
关键词:
microembolic signal;
carotid endarterectomy;
transcranial Doppler;
stroke;
D O I:
10.1159/000099135
中图分类号:
R74 [神经病学与精神病学];
学科分类号:
摘要:
Purpose: Post-operatively detected transcranial Doppler (TCD) embolic signals (ES) are associated with an increased risk of carotid endarterectomy (CEA) stroke/TIA. The aims here were to quantify this risk and determine the most efficient monitoring protocol. Methods: Sequential patients undergoing CEA (enrolled in a randomised, blinded, placebocontrolled trial of peri-operative dextran therapy) had 30-min TCD monitoring in the first post-operative hour. 30-min monitoring was also performed 2-3, 4-6 and 24-36 h post- operatively. First post-operative hour ES counts were correlated with peri-operative ipsilateral carotid stroke/TIA to determine the size of a clinically significant ES load and the magnitude of the associated risk. The exact Cochran-Armitage test for trend in proportions was used to determine when a clinically significant ES load was first detected. Results: 141 patients (mean age 69.3 years, 72% male) were monitored during the first post-operative hour. An ES count 1 10 per recording was identified as the best overall predictor of ipsilateral stroke/TIA (sensitivity 72%, specificity 89%). 3/119 (2.5%) patients with 0-10 ES had ipsilateral carotid events compared to 8/22 (36.4%) patients with 11-115 ES (OR = 22.1, 95% CI 4.5, 138.4, p < 0.0001). 13/18 (72%) of subjects with > 10 ES were identified in the first post-operative hour with no significant increase in the number of new cases over the subsequent 24-36 post-operative h (p = 0.354). Conclusion: Patients with clinically significant post-operative microembolism had an approximately 15 times higher risk of ipsilateral stroke/TIA and most were identified during a 30-min study in the first post-operative hour.
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页码:362 / 367
页数:6
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