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.
引用
收藏
页码:362 / 367
页数:6
相关论文
共 39 条
[1]   NON-INVASIVE TRANSCRANIAL DOPPLER ULTRASOUND RECORDING OF FLOW VELOCITY IN BASAL CEREBRAL-ARTERIES [J].
AASLID, R ;
MARKWALDER, TM ;
NORNES, H .
JOURNAL OF NEUROSURGERY, 1982, 57 (06) :769-774
[2]   THE SIGNIFICANCE OF MICROEMBOLI DETECTION BY MEANS OF TRANSCRANIAL DOPPLER ULTRASONOGRAPHY MONITORING IN CAROTID ENDARTERECTOMY [J].
ACKERSTAFF, RGA ;
JANSEN, C ;
MOLL, FL ;
VERMEULEN, FEE ;
HAMERLIJNCK, RPHM ;
MAUSER, HW .
JOURNAL OF VASCULAR SURGERY, 1995, 21 (06) :963-969
[3]   Association of intraoperative transcranial Doppler monitoring variables with stroke from carotid endarterectomy [J].
Ackerstaff, RGA ;
Moons, KGM ;
van de Vlasakker, CJW ;
Moll, FL ;
Vermeulen, FEE ;
Algra, A ;
Spencer, MP .
STROKE, 2000, 31 (08) :1817-1823
[4]   Cerebral microembolism and ischemic changes associated with carotid endarterectomy [J].
Cantelmo, NL ;
Babikian, VL ;
Samaraweera, RN ;
Gordon, JK ;
Pochay, VE ;
Winter, MR .
JOURNAL OF VASCULAR SURGERY, 1998, 27 (06) :1024-1030
[5]   Oxygen inhalation can differentiate gaseous from nongaseous microemboli detected by transcranial Doppler ultrasound [J].
Droste, DW ;
Hansberg, T ;
Kemeny, V ;
Hammel, D ;
SchulteAltedorneburg, G ;
Nabavi, DG ;
Kaps, M ;
Scheld, HH ;
Ringelstein, EB .
STROKE, 1997, 28 (12) :2453-2456
[6]   Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European carotid surgery trial (ECST) [J].
Farrell, B ;
Fraser, A ;
Sandercock, P ;
Slattery, J ;
Warlow, CP .
LANCET, 1998, 351 (9113) :1379-1387
[7]   The North American Symptomatic Carotid Endarterectomy Trial - Surgical results in 1415 patients [J].
Ferguson, GG ;
Eliasziw, M ;
Barr, HWK ;
Clagett, GP ;
Barnes, RW ;
Wallace, MC ;
Taylor, DW ;
Haynes, RB ;
Finan, JW ;
Hachinski, VC ;
Barnett, HJM .
STROKE, 1999, 30 (09) :1751-1758
[8]   ON-TABLE DIAGNOSIS OF INCIPIENT CAROTID-ARTERY THROMBOSIS DURING CAROTID ENDARTERECTOMY BY TRANSCRANIAL DOPPLER SCANNING [J].
GAUNT, ME ;
RATLIFF, DA ;
MARTIN, PJ ;
SMITH, JL ;
BELL, RRF ;
NAYLOR, AR .
JOURNAL OF VASCULAR SURGERY, 1994, 20 (01) :104-107
[10]   CLINICAL RELEVANCE OF INTRAOPERATIVE EMBOLIZATION DETECTED BY TRANSCRANIAL DOPPLER ULTRASONOGRAPHY DURING CAROTID ENDARTERECTOMY - A PROSPECTIVE-STUDY OF 100 PATIENTS [J].
GAUNT, ME ;
MARTIN, PJ ;
SMITH, JL ;
RIMMER, T ;
CHERRYMAN, G ;
RATLIFF, DA ;
BELL, PRF ;
NAYLOR, AR .
BRITISH JOURNAL OF SURGERY, 1994, 81 (10) :1435-1439