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Clinical value of carotid ultrasound in evaluating ischemic stroke risk in elderly patients with spinal diseases
- CHEN Xi, LIU Xinyu, FAN Lixia, TIAN Yonghao, YUAN Suomao
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Journal of Shandong University (Health Sciences). 2019, 57(5):
48-55.
doi:10.6040/j.issn.1671-7554.0.2019.006
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Objective To analyze the clinical value of preoperative carotid Doppler ultrasound with magnetic resonance angiography(MRA)to assess the risk of postoperative ischemic stroke in elderly patients with spinal diseases. Methods 山 东 大 学 学 报 (医 学 版)57卷5期 -陈希,等.老年脊柱疾病应用颈动脉超声评估缺血性脑卒中风险的临床价值 \=-During Jan. 2014 and Dec. 2017, 269 patients who received general anesthesia due to spinal diseases were divided into the screening and non-screening groups. The screening group(n=131)included 61 male and 70 female, aged 50-83 years, average(62.16±7.64)years. Hypertension was found in 112 cases, diabetes in 19 cases, coronary heart disease in 21 cases and cerebrovascular diseases in 11 cases. The screening group was then subdivided into three age groups: 50-55, 56-65 and >65 years. The non-screening group(n=138)included 66 male and 72 female, aged 50-77 years, average(61.33±5.93)years. Hypertension was found in 108 cases, diabetes in 13 cases, coronary heart disease in 18 cases, and cerebrovascular diseases in 12 cases. For the screening group, the blood flow velocity of internal carotid artery, thickness of intima-media thickness(IMT), thickness of plaques, and the degrees of carotid artery stenosis(mild, moderate and severe)were measured. Patients with carotid artery stenosis underwent craniocerebral MRA, and the risk of postoperative ischemic stroke was evaluated by neurologists and anesthesiologists. Conservative treatment was recommended to those who had surgical contraindications. The incidence of postoperative stroke and relevant factors were evaluated. Results In the screening group, 57 cases(43.5%)showed carotid stenosis(mild stenosis in 44 cases, moderate stenosis in 8 cases, severe stenosis in 5 cases), and craniocerebral MRA showed 53 cases had cerebral abnormalities ［24 male, 29 female, aged 52-81 years, average(65.5±7.45)years］. There were 32 cases with no absolute contraindications, 11 cases with high surgical risks, and 10 of which turned to conservative treatment. After operation, ischemic stroke occurred in 6 cases in the non-screening group but in no case in the screening group(P=0.045). According to the age stratification, patients aged ≥65 years had higher risk of moderate and severe carotid stenosis than the other two age groups (P=0.001, P=0.006), and had a higher rate of contraindications than the 56-65 years group (P=0.021). Patients with severe carotid artery stenosis and abnormal brain MRA had higher operative risk than those with mild-mederate stenosis (P=0.007). Compared with patients with stable plaques, those with unstable plaques had higher risk of moderate or severe carotid stenosis (P<0.001), lower level of HDL-C ［(1.22±0.26)mmol/L vs(1.39±0.31)mmol/L, P=0.036), higher level of LDL-C ［(3.02±0.88)mmol/L vs(2.59±0.64), P=0.038］, but there was no difference in the rate of surgical contraindications(P=0.879). Multivariate logistic analysis showed that old age and history of cerebrovascular diseases were risk factors of carotid artery stenosis. Conclusion Carotid Doppler ultrasound screening can be used as a tool for preoperative assessment of ischemic stroke risk in elderly patients with spinal diseases. Combined craniocerebral MRA screening can effectively improve the accuracy of assessment and promote the safety of surgery.
