Transcranial color Doppler ultrasonography for the assessment of anterior communicating artery ;patency in patients with severe carotid artery stenosis
10.3969/j.issn.1672-5921.2016.02.004
- VernacularTitle:经颅彩色多普勒超声对重度颈动脉狭窄行颈动脉内膜切除术患者前交通动脉开放的评价
- Author:
Yinghua ZHOU
;
Yang HUA
;
Chen LING
;
Chun DUAN
;
Lili WANG
;
Weihong HOU
- Publication Type:Journal Article
- Keywords:
Carotid stenosis;
Endarterectomy,carotid;
Anterior communicating artery;
Ultrasonography,doppler,color;
Hemodynamics
- From:
Chinese Journal of Cerebrovascular Diseases
2016;(2):72-77
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the evaluation value of anterior communicating artery patency for patients with severe carotid artery stenosis treated by carotid endarterectomy (CEA )with transcranial color Doppler ultrasonography. Methods From June 2014 to June 2015,89 consecutive inpatients with unilateral symptomatic severe carotid stenosis treated with CEA at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were enrolled retrospectively. They were divided into either a patent group (n=45)or a non-patent group (n=44)according to whether the anterior communicating artery was patent or not (DSA findings). Whether the anterior communicating artery was patent or not diagnosed by the transcranial color Doppler ultrasonography was compared with the consistency of the digital subtraction angiography (DSA)results. The differences of intraoperatively implemented temporary shunt rate and the differences of hemodynamic parameters including peak velocity (PSV),end-diastolic velocity (EDV),and pulsatility index (PI)of the preoperative and postoperative bilateral middle cerebral artery and anterior cerebral artery (ACA)of both groups were analyzed. Results Compared with the results of DSA, the sensitivity and specificity of transcranial color Doppler ultrasonography for preoperative evaluation of the patency of anterior communicating artery were 91. 1%(41/45)and 97. 7%(43/44)respectively,the total accordance rate was 94. 4%(84/89)(Kappa=0. 888,P<0. 01). The temporary shunt rate (2. 2%[1/45])of patients in CEA of the anterior communicating artery patent group was significantly lower than that of the non-patent group (20. 5%[9/44]). There was significant difference between the 2 groups (χ2 =5. 700,P =0. 017). PSV,EDV,and PI of the ipsilateral middle cerebral artery after procedure in both groups were higher than those before procedure. There were significant differences (the patent group:128 ± 41 cm/s vs. 77 ± 24 cm/s,55 ± 18 cm/s vs. 41 ± 13 cm/s,and 0. 92 ± 0. 14 vs. 0. 67 ± 0. 14;the non-patent group:139 ± 44 cm/s vs. 86 ± 31 cm/s,59 ± 22 cm/s vs. 44 ± 16 cm/s,and 0. 94 ± 0. 15 vs. 0.71 ± 0. 16;all P<0. 01). PSV and EDV of the contralateral ACA of the patent group were decreased after procedure. There were significant differences (125 ± 42 cm/s vs. 157 ± 57 cm/s,55 ± 24 cm/s vs. 72 ± 34 cm/s,all P<0. 01). There was no significant difference in PI of contralateral ACA before and after procedure (P >0.05). There were no significant differences in PSV,EDV and PI of the contralateral ACA in the non-patent group between after procedure and before procedure (all P>0. 05). Conclusions Transcranial color Doppler ultrasonography can accurately and objectively evaluate whether the anterior communicating artery is patent or not in patients with unilateral severe carotid stenosis. It has an important clinical significance for selective shunt in CEA and improving the success rate of CEA.
