Dokument: RISIKEN FRÜHER MIKROEMBOLISATION UND CEREBRALER ISCHÄMIEN NACH THROMBENDARTERIEKTOMIE
| Titel: | RISIKEN FRÜHER MIKROEMBOLISATION UND CEREBRALER ISCHÄMIEN NACH THROMBENDARTERIEKTOMIE | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=13127 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20091019-091755-7 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Brosig, Torge [Autor] | |||||||
| Dateien: |
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| Beitragende: | Prof. Dr. Siebler, Mario [Gutachter] Prof. Dr. Siebler, Mario [Gutachter] Prof. Dr. Haas, Helmut L. [Gutachter] | |||||||
| Stichwörter: | Microembolie, Doppler, Thrombendarteriektomie, cerebrale Ischämie | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Hintergrund: Cerebrale Mikroemboliesignale (MES) nach
Carotisthrombendarteriektomie (CEA) werden mit einem erhöhten Risiko eines postoperativen Schlaganfalls in Verbindung gebracht. In dieser Studie wurde die Beziehung eines intraoperativ mittels Ultraschall bestimmten Turbulenzindex (TI) während CEA und dem postoperativen Vorkommen von MES untersucht. Methoden: Eine 15minütige MES-Detektion der ipsilateralen Arteria cerebri media konnte bei 164 Patienten (Durchschnittsalter 64, 140 männliche Patienten) innerhalb von 4 Stunden nach CEA im Aufwachraum durchgeführt werden. Mit einer speziellen cw-Ultraschall-Dopplersonde konnte der TI in der rekonstruierten Arteria Carotis Interna (ACI) während des operativen Eingriffs gemessen werden. Ergebnisse: Die Wahrscheinlichkeit postoperativer cerebraler Mikroembolisation nach CEA ist in der Gruppe mit TI>26 signifikant höher als für TI<26. Ein TI>26 sagt cerebrale MES mit einer Sensitivität von 71% und einer Spezifität von 76% voraus. MES-Anzahl und TI-Wert waren bei Patienten, welche mit der Eversionstechnik operiert wurden, signifikant erhöht (p=0,005) im Vergleich zu Patienten, welche mit der Patch-Technik operiert wurden. Weder für präoperative Mikroembolisation der ipsilateralen ACI, noch die Operationsseite, noch das Alter der Patienten oder den Stenosegrad konnte ein Einfluss auf postoperative MES festgestellt werden. Weibliche Patienten haben ein signifikant höheres Risiko für postoperative MES als männliche Patienten (p=0,003). Diskussion: Eine vereinfachte intraoperative Dopplersonographie mit Bestimmung des TI oder kurzzeitige postoperative MES-Detektion nach CEA sind gut durchführbare und möglicherweise hilfreiche Methoden für eine postoperative chirurgische Qualitätskontrolle und weitere präventive Behandlungsstrategien.BACKGROUND: Cerebral microembolic signals (MES) after carotid endarterectomy (CEA) are associated with an increased risk of postoperative stroke. We investigated the relationship of an intraoperatively recorded ultrasound turbulence index (TI) during CEA and the occurrence of MES. METHODS: Short-time MES detection was performed on 164 patients (mean age 64 years, 140 males) in the ipsilateral middle cerebral artery within 2 h after CEA. A specialized continuous-wave ultrasound Doppler probe measured the TI within the reconstructed internal carotid artery during surgery. RESULTS: The occurrence of postoperative MES increased significantly with the TI: a TI >26 predicted MES with a sensitivity of 72% and a specificity of 76%. The MES rate and TI were higher in patients operated with the eversion technique than in patients operated with the patch technique (p = 0.005). There was no relationship with preoperative MES, site of surgery or age of patients. Female patients had a higher risk of postoperative MES than males (p = 0.003). CONCLUSIONS: Simplified intraoperative Doppler sonography or short-time MES detection after CEA are feasible, and may be helpful for surgical quality control and decision making (e.g. treatment with platelet antagonists). | |||||||
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| Lizenz: |  Urheberrechtsschutz | |||||||
| Bezug: | 2001-2009 Düsseldorf | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 19.10.2009 | |||||||
| Dateien geändert am: | 16.10.2009 | |||||||
| Promotionsantrag am: | 10.03.2009 | |||||||
| Datum der Promotion: | 10.03.2009 |
