The CDFI United TCD Testing And Evaluation Before And After Carotid Endarterectomy

Background and Objective: Carotid endarterectomy (CEA) is a surgicaltreatment of carotid atherosclerosis stenosis standard technique. In order to ensuresuccessful operation and safety and reduce surgical complications, the choice ofnon-invasive detection technology for CEA preoperative diagnosis, screening,postoperative evaluation and long-term follow-up is important. In this study, ColorDoppler Flow Imaging (CDFI) united Transcranial Doppler(TCD), carotidendarterectomy (CEA) in patients with preoperative, intraoperative intracranial andextracranial vascular parameters of a comprehensive test to evaluate the efficacy andexplore its value in clinical application.Methods: Retrospective analysis of cerebral angiography (Digital subtractionangiography, DSA) diagnosed with cerebral ischemic symptoms of carotid arterystenosis (restenosis rate≥70%) and accept the CEA treatment of50patients, CDFIand TCD measurement of CEA treatment before and aftercarotid stenosis local diameterstenosis rate, narrow section of peak systolic velocity (peak systolic Velocity, PSV), enddiastolic velocity (End diastolic Velocity, EDV), narrow section of blood flow (BloodFlow Volume, BFV), stenosis of the distal vascular resistance index (resistance Index,RI2), common carotid artery (CCA) PSV calculated PSVICA/PSVCCAratio, theipsilateral middle cerebral artery (MCA), MCA pulsatility index (pulsatility index, PI),based on the detectedanalysis of intracranial arterial collateral circulation situation, andone month after surgery, six months, one year follow-up, the comparative analysis ofpreoperative and postoperative parameters, all patients after12months DSA(Digitalsubtraction angiography, DSA) or CT angiography (CT angiography, CTA)examination, preoperative and postoperative ultrasound diagnosis of stenosis resultswere compared with DSA or CTA. Results:50cases of patients with CEA preoperative CDFI、TCD detection results:the degree of stenosis of50%-69%of1cases,70%-99%of47cases, compared withDSA, preoperative ultrasound stenosis accuracy rate of96.00%(48/50). ACoA open toparticipate in the36cases of collateral circulation, in line with the DSA rate of94.7%(36/38),14cases of the the PCoA open participation in collateral circulation, inaccordance with the rate of82.3%(14/17) and DSA. The inner diameter of the month ofthe original50patients with carotid artery stenosis of carotid endarterectomy narrowsignificantly widened, and ipsilateral carotid stenosis at PSV, EDV, BFV, narrow distalRI, MCA, PIMCA restore normal side branch circulation all closed. The diameter ofcarotid artery increased from (1.84±0.72)mm to (5.75±0.87)mm one month after theCEA(P<0.05), narrow PSV and EDV decreased from (287.43±64.27) cm/s、(112.3±21.5) cm/s, reduced to (66.52±19.36) cm/s、(25.30±5.90) cm/s,narrow at the blood flow volume increased from (163.4±53.7) ml/min to (246.2±68.6) ml/min, resistance index of distal segment carotid artery increased from(0.54±0.11) to (0.62±0.09), PSVICA/PSVCCAdecreased from (4.66±0.81) to(1.07±0.44)(P<0.05); ipsilateral brain MCA PSV preoperative (43.82±23.53)cm/s increased to (89.39±16.76) cm/s, PIMCA values increased frompreoperative (0.59±0.39) to (0.87±0.19)(P<0.05). Three postoperative follow-up(1month,6months,12months) the hemodynamic parameters before surgery werestatistically significant (P<0.05). after6months,12months, surgery1month aftershowed no significant difference (P>0.05). In the CDFI with TCD during follow-up12months after surgery, all patients were not found to significantly restenosis, follow-upresults are consistent with DSA or CTA.Conclusion: CDFI and TCD Joint Inspection objective assessment of the CEAtreatment effect according to the hemodynamic changes in intracranial and extracranialpostoperative able to detect endometrial muscle hyperplasia and restenosis, preoperativestenosis diagnosis、analysis of the collateral circulation，are in good agreement with theDSA.provide important information for clinical treatment. Long-term postoperativefollow-up in patients with ischemic cerebrovascular disease, provide a morecomprehensive, safe and effective rehabilitation intervention reference. on patients withischemic cerebrovascular disease CEA preoperative screening, diagnosis, postoperativeevaluation and follow-up is very important clinical significance.