The prediction of the security of carotid endarterectomy by the assessment of cerebral collateral circulation / 中华医学超声杂志（电子版）

ABSTRACT

Objective The aim of this study is to investigate whether functional intracranial collateral circulation can predict the security of carotid endarterectomy (CEA) by transcranial doppler (TCD) combined with transcranial color code duplex (TCCD) preoperatively.Methods A total of 437 patients with carotid stenosis undergone CEA surgeries from January 2013 to November 2015 were included in this study.According to the functional intracranial collateral artery via TCD and TCCD,patients were divided into four groups(A) anterior communicative artery (ACoA) (B) posterior communicative artery (PCoA) (C) both ACoA and PCoA and (D) external-internal carotid artery (E-ICA) or no communicative artery.Velocities and the pulsatility index (PI) of the ipsilateral middle cerebral artery (MVMCA) were compared among the four groups during clamping and de-clamping period.Results After clamping,there were significant difference of decreasing scale of MVMCA and PIMCA among the four groups (F=43.737,P＜0.001;F=9.298,P ＜ 0.001),especially for the group D (t=9.330607,0.488951,t=5.534661,2.797039,t=10.0751,0.488951;all P ＜ 0.005).After de-clamping,compared with the baseline,there were also significant difference of increasing scale of MVMCA and PIM CA among the four groups (F=6.260,2.840,all P ＜ 0.05);compared with clamping,there were also significant difference of increasing scale of MVMCA among the four groups (H=62.210,P ＜ 0.001),the increasing scale of MVMCA for group D was significant higher than the other three groups (t=4.104773,2.190371,3.06337,all P ＜ 0.005).However,there was no differences of increasing scale of PIMCA among the four groups (P ＞ 0.05).The occurrence of cerebral hyperperfusion syndrome (CHS) were in significant differences (x2=13.255,P=0.004) among the four groups.Higher occurrence rate of CHS was found in group D compared with groups A and C (H=8.734,6.764,all P ＜ 0.01).Insufficient intracranial collateral circulation was an independent risk factor for CHS (OR=5.917,95％CI1.325-26.415,P=0.02).Conclusion The evaluation of intracranial collateral circulation with TCD combined with TCCD can help to predict potential risk of CHS preoperatively,and improve the safety of CEA.