RESUMO
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Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Braço/irrigação sanguínea , Embolia Paradoxal/complicações , Isquemia/complicações , Perna (Membro)/irrigação sanguínea , Embolia Pulmonar/complicações , Tromboembolia/complicações , Trombose Venosa/complicações , Doença Aguda , Embolia Paradoxal/diagnóstico , Isquemia/diagnóstico , Embolia Pulmonar/diagnóstico , Tromboembolia/diagnóstico , Trombose Venosa/diagnósticoRESUMO
Objetivos. Determinar la correlación entre la oximetría y el Doppler transcraneal (DTC) durante y después de la angioplastia- stent carotídeo con interrupción de flujo, y valorar la hipoperfusión y su recuperación durante el procedimiento. Pacientes y métodos. En 18 pacientes intervenidos de angioplastia-stent carotídeo, se registraron, de forma prospectiva, la velocidad de flujo en la arteria cerebral media y la saturación del oxígeno transcutáneo. La monitorización fue basal y a los minutos 1, 3, 5, 10 y 15 tras la oclusión y apertura del flujo. Las medidas, en unidades y porcentajes de cambio, se estratificaron por grupos en leves, moderadas y graves. Se estudió la concordancia entre ambas pruebas. Resultados. Tiempo de oclusión: 8,2 ± 2,7 minutos. Dos pacientes (11,1%) presentaron hipoperfusión cerebral. En dos pacientes se reinstauró el flujo por valor crítico. Media de valores basales: 56,3 ± 11,4 cm/s (DTC) y 67,6 ± 7,1% (oximetría). Valorando los cambios de los valores absolutos y porcentajes de cambio entre el DTC y la oximetría, fueron concordantes en la oclusión (rho = 0,8-0,9; p < 0,05), con asociación menor al reinstaurar el flujo (rho = 0,4-0,8; p < 0,05). En porcentajes de cambio hubo concordancia muy buena en la oclusión (kappa = 0,8-1; p < 0,05). La concordancia fue buena (kappa = 0,68; p < 0 05) en los minutos 1, 3 y 5 tras la apertura del flujo. Conclusiones. Hubo correlación significativa entre los métodos durante la interrupción del flujo carotídeo, por lo que pueden utilizarse de forma independiente. El 88,9% se mantuvo en un umbral seguro de isquemia cerebral y, dado que el procedimiento puede realizarse con breves interrupciones, el control por oximetría o DTC puede resultar igualmente seguro en la valoración de la isquemia cerebral (AU)
Aims. To determine the correlation between oximetry and transcranial Doppler ultrasonography (TDU) during and following carotid stent-angioplasty with flow interruption, and to evaluate the level of hypoperfusion and its recovery during the procedure. Patients and methods. Records were made, prospectively, of the flow rates in the middle cerebral artery and the transcutaneous oxygen saturation of 18 patients who had undergone surgery to perform a carotid stent-angioplasty. Monitoring was basal and at 1, 3, 5, 10 and 15 minutes after stopping and opening the flow. Measurements, in units and percentages of change, were stratified by groups as mild, moderate and severe. The agreement between the two tests was studied. Results. Occlusion time: 8.2 ± 2.7 minutes. Two patients (11.1%) presented cerebral hypoperfusion. Flow was re-established in two patients due to its reaching critical values. Mean of the baseline values: 56.3 ± 11.4 cm/s (TDU) and 67.6 ± 7.1% (oximetry). The changes in the absolute values and percentages of change between TDU and oximetry were evaluated and results showed an agreement between them in occlusion (rho = 0.8-0.9; p < 0.05), with less association on reestablishing the flow (rho = 0.4-0.8; p < 0.05). In percentages of change there was very good agreement in occlusion (kappa = 0.8-1; p < 0.05). Agreement was good (kappa = 0.68; p < 0.05) at 1, 3 and 5 minutes after opening up the flow. Conclusions. A significant correlation was found between the methods during the interruption of carotid flow, which means they can be used independently. Overall, 88.9% remained below the safety threshold for cerebral ischaemia and, given that the procedure can be carried out with brief interruptions, control by oximetry or TDU can be just as safe in evaluating cerebral ischaemia (AU)
Assuntos
Humanos , Estenose das Carótidas/cirurgia , Angioplastia/métodos , Hemodinâmica , Monitorização Fisiológica/métodos , Ultrassonografia Doppler Transcraniana/métodos , Oximetria , Fatores de RiscoRESUMO
AIMS: To determine the correlation between oximetry and transcranial Doppler ultrasonography (TDU) during and following carotid stent-angioplasty with flow interruption, and to evaluate the level of hypoperfusion and its recovery during the procedure. PATIENTS AND METHODS: Records were made, prospectively, of the flow rates in the middle cerebral artery and the trans-cutaneous oxygen saturation of 18 patients who had undergone surgery to perform a carotid stent-angioplasty. Monitoring was basal and at 1, 3, 5, 10 and 15 minutes after stopping and opening the flow. Measurements, in units and percentages of change, were stratified by groups as mild, moderate and severe. The agreement between the two tests was studied. RESULTS: Occlusion time: 8.2 +/- 2.7 minutes. Two patients (11.1%) presented cerebral hypoperfusion. Flow was re-established in two patients due to its reaching critical values. Mean of the baseline values: 56.3 +/- 11.4 cm/s (TDU) and 67.6 +/- 7.1% (oximetry). The changes in the absolute values and percentages of change between TDU and oximetry were evaluated and results showed an agreement between them in occlusion (rho = 0.8-0.9; p < 0.05), with less association on re-establishing the flow (rho = 0.4-0.8; p < 0.05). In percentages of change there was very good agreement in occlusion (kappa = 0.8-1; p < 0.05). Agreement was good (kappa = 0.68; p < 0.05) at 1, 3 and 5 minutes after opening up the flow. CONCLUSIONS: A significant correlation was found between the methods during the interruption of carotid flow, which means they can be used independently. Overall, 88.9% remained below the safety threshold for cerebral ischaemia and, given that the procedure can be carried out with brief interruptions, control by oximetry or TDU can be just as safe in evaluating cerebral ischaemia.
