神经电生理监测联合荧光血管造影用于CEA疗效评估

CEA Efficacy Evaluation of Neuroelectrophysiological Monitoring Combined with Fluorescence Angiography

摘要: 目的：探讨在治疗颈动脉粥样硬化性狭窄手术中，运用神经电生理实时监测和荧光造影辅助下的临床疗效。方法：收集2021年1月至2023年1月术中神经电生理监测联合荧光造影下行颈动脉内膜剥脱术(carotid endarterectomy, CEA)治疗的90例103侧颈动脉狭窄的临床资料，其中13例是双侧狭窄，先后接受两次手术治疗，采用经典式或者翻转式CEA，术中采用神经电生理技术监测躯体感觉诱发电位(somato sensory evoked potential, SEP)和躯体运动诱发电位(motion evoked potential, MEP)波幅的改变，使用吲哚菁绿(indocyanine green, ICG)血管造影和FLOW 800计算机整合软件分析技术，评估颈动脉斑块切除前后血管荧光显影。结果：术中神经电生理监测未见波幅异常94例，有异常监测指标9例，MEP异常检测指标6例、SEP异常检测指标7例，MEP和SEP同时出现异常检测指标4例，术后神经功能均良好，无遗留神经功能障碍病例。ICG造影均显示术侧颈动脉术后血流通畅，术后1、6个月复诊，均无遗留神经功能障碍。9例术后再狭窄，均为轻度狭窄无症状。结论：术中神经电生理监测联合荧光造影下颈动脉内膜剥脱术治疗颈动脉粥样硬化性狭窄是一种实用、高效、稳妥的方法，可为术者及时反馈神经功能信息，并评估脑供血情况和组织灌注状态，术中应用ICG荧光造影对术中明确斑块位置、避免斑块残余、预防脑缺血或过度灌注有重要作用，提高手术的成功率，降低术后并发症的发生率，有效改善患者的预后。

Abstract: Aim: To investigate the clinical effect of real-time neurophysiological monitoring and fluorescein angiography in the treatment of carotid atherosclerotic stenosis. Method: Clinical data of 103 carot-id artery strictures in 90 cases with intraoperative neurophysiological monitoring combined with carotid endarterectomy under fluorescence angiography were collected from January 2021 to Jan-uary 2023. Among them, 13 cases were bilateral strictures, which were treated with classic or in-verted CEA. During the operation, the changes of somatosensory evoked potential and somatomotor evoked potential amplitude were monitored by neuroelectrophysiological techniques. Indocyanine green angiography and FLOW 800 computer integrated software analysis techniques were used to evaluate vascular fluorescence imaging before and after carotid plaque resection. Results: In-traoperative neuroelectrophysiological monitoring showed no abnormal amplitude in 94 cases, ab-normal monitoring indicators in 9 cases, abnormal MEP detection indicators in 6 cases, abnormal SEP detection indicators in 7 cases, and abnormal MEP and SEP detection indicators in 4 cases. All the postoperative neurological functions were good, and no cases of residual neurological dysfunc-tion were found. ICG angiography showed unobstructed carotid blood flow after operation, and no residual neurological dysfunction was found at 1 and 6 months after surgery. Restenosis occurred in 9 cases, all of which were mild and asymptomatic. Conclusion: Intraoperative nerve electrophysio-logical monitoring combined with carotid endarterectomy under fluorescence angiography is a practical, efficient and secure method for the treatment of carotid atherosclerotic stenosis, which can provide timely feedback of nerve function information and evaluate the cerebral blood supply and tissue perfusion status. Intraoperative ICG fluorography plays an important role in determining the location of plaques, avoiding plaque residual, preventing cerebral ischemia or overperfusion, improving the success rate of surgery, reducing the incidence of postoperative complications, and effectively improving the prognosis of patients.