Transcranial Doppler in 178 patients before, during, and after carotid endarterectomy
From July 1991 to March 1995, 178 patients who underwent 198 carotid surgical repairs were investigated preoperatively, intraoperatively, and postoperatively by transcranial Doppler sonography (TCD). Preoperative TCD evaluation showed stenosis of the middle cerebral artery (MCA) in 4 patients (2.2%)...
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Published in | Journal of neuroimaging Vol. 7; no. 4; p. 213 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
United States
01.10.1997
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Abstract | From July 1991 to March 1995, 178 patients who underwent 198 carotid surgical repairs were investigated preoperatively, intraoperatively, and postoperatively by transcranial Doppler sonography (TCD). Preoperative TCD evaluation showed stenosis of the middle cerebral artery (MCA) in 4 patients (2.2%), siphon stenosis in 3 (1.6%), incomplete circle of Willis in 23 (12.9%), a decrease of mean blood flow velocity more than 70% of the basal value during digital common carotid compression in 31 (17.9%), and a critical reduction of vasomotor reactivity (no significant increase of mean blood flow velocity in the MCA during breath-holding test) in 34 (19.1%). Nine patients (5%) had surgery without preoperative angiography. In those patients the indication for surgery was based on color Doppler imaging and TCD investigations. Ninety surgical procedures were carried out under general anesthesia and 188 under locoregional anesthesia. In 37 surgeries (31.7%) a shunt was inserted. The use of a shunt was based on a decrease of mean blood flow velocity in the MCA below 50% of the basal value under general anesthesia or loss of consciousness combined with a decrease of mean blood flow velocity in the MCA higher than 70% of the basal value when locoregional anesthesia was employed. Intraoperative TCD monitoring showed a decrease of mean blood flow velocity in the MCA due to shunt malfunction in (8.3%) of 36 surgeries, turbulence of blood flow during declamping in 79 procedures (39.8%), and microembolic events in 10 patients (5%) that were related to one transient and one permanent neurological deficit. Another permanent deficit occurred in a patient without TCD signs. After surgery, TCD reliably detected an early asymptomatic occlusion of the carotid artery, hyperperfusion syndrome in 12 (6.0%), and an increase of vasomotor reactivity in 10 (29.4%) of 34 surgeries. |
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AbstractList | From July 1991 to March 1995, 178 patients who underwent 198 carotid surgical repairs were investigated preoperatively, intraoperatively, and postoperatively by transcranial Doppler sonography (TCD). Preoperative TCD evaluation showed stenosis of the middle cerebral artery (MCA) in 4 patients (2.2%), siphon stenosis in 3 (1.6%), incomplete circle of Willis in 23 (12.9%), a decrease of mean blood flow velocity more than 70% of the basal value during digital common carotid compression in 31 (17.9%), and a critical reduction of vasomotor reactivity (no significant increase of mean blood flow velocity in the MCA during breath-holding test) in 34 (19.1%). Nine patients (5%) had surgery without preoperative angiography. In those patients the indication for surgery was based on color Doppler imaging and TCD investigations. Ninety surgical procedures were carried out under general anesthesia and 188 under locoregional anesthesia. In 37 surgeries (31.7%) a shunt was inserted. The use of a shunt was based on a decrease of mean blood flow velocity in the MCA below 50% of the basal value under general anesthesia or loss of consciousness combined with a decrease of mean blood flow velocity in the MCA higher than 70% of the basal value when locoregional anesthesia was employed. Intraoperative TCD monitoring showed a decrease of mean blood flow velocity in the MCA due to shunt malfunction in (8.3%) of 36 surgeries, turbulence of blood flow during declamping in 79 procedures (39.8%), and microembolic events in 10 patients (5%) that were related to one transient and one permanent neurological deficit. Another permanent deficit occurred in a patient without TCD signs. After surgery, TCD reliably detected an early asymptomatic occlusion of the carotid artery, hyperperfusion syndrome in 12 (6.0%), and an increase of vasomotor reactivity in 10 (29.4%) of 34 surgeries. |
Author | Martinelli, O Guerricchio, R Benedetti-Valentini, F Irace, L Gossetti, B |
Author_xml | – sequence: 1 givenname: B surname: Gossetti fullname: Gossetti, B organization: 2nd Chair of Vascular Surgery, La Sapienza University of Roma, Italy – sequence: 2 givenname: O surname: Martinelli fullname: Martinelli, O – sequence: 3 givenname: R surname: Guerricchio fullname: Guerricchio, R – sequence: 4 givenname: L surname: Irace fullname: Irace, L – sequence: 5 givenname: F surname: Benedetti-Valentini fullname: Benedetti-Valentini, F |
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SubjectTerms | Anesthesia, Conduction Anesthesia, General Apnea - physiopathology Arterial Occlusive Diseases - diagnostic imaging Arterial Occlusive Diseases - surgery Arteriovenous Shunt, Surgical Blood Flow Velocity Carotid Artery, Common - diagnostic imaging Carotid Stenosis - diagnostic imaging Carotid Stenosis - etiology Cerebral Angiography Cerebral Arterial Diseases - diagnostic imaging Cerebral Arterial Diseases - surgery Cerebral Arteries - diagnostic imaging Cerebrovascular Circulation Circle of Willis - diagnostic imaging Circle of Willis - surgery Constriction, Pathologic - diagnostic imaging Constriction, Pathologic - surgery Endarterectomy, Carotid Hemorheology Humans Intracranial Embolism and Thrombosis - diagnostic imaging Intracranial Embolism and Thrombosis - etiology Ischemic Attack, Transient - diagnostic imaging Ischemic Attack, Transient - surgery Monitoring, Intraoperative Neurologic Examination Postoperative Care Reproducibility of Results Ultrasonography, Doppler, Color Ultrasonography, Doppler, Transcranial Vasomotor System - diagnostic imaging Vasomotor System - physiopathology |
Title | Transcranial Doppler in 178 patients before, during, and after carotid endarterectomy |
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