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Intraoperative transcranial Doppler sonography monitoring during carotid surgery under locoregional anaesthesia.
- Source :
-
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 1996 Nov; Vol. 12 (4), pp. 407-11. - Publication Year :
- 1996
-
Abstract
- Objectives: Studies comparing transcranial Doppler ultrasonography (TCD) with other intraoperative monitoring techniques for detecting clamping ischaemia during carotid endarterectomy under general anaesthesia suggest that a reduction of > two-thirds in the mean middle cerebral artery velocity (mMCAv) or a reduction of > 0.4 in the preclamping mMCAv: clamping mMCAv ratio warrants cerebral protection. Our aim was to study the relationship between mMCAvs and clamping ischaemia during carotid endarterectomy in awake patients.<br />Materials and Methods: In a consecutive series of 57 patients undergoing carotid endarterectomy under locoregional anaesthesia 51 were monitored by intraoperative TCD, continuous EEG, and neurologic awake testing.<br />Results: Five of the 51 (9.8%) patients had transient clamping ischaemia, which carotid shunting reversed. TCD showed that these five patients had significant lower mean mMCAvs than the other 46 patients, who had no deficits (1.8 +/- 1.1 cm/s vs. 26.2 +/- 8.5, p = 0.0003). Current TCD criteria indicated that four other patients (7.8%) should have been shunted. All four had significantly higher clamping mMCAvs than the five shunted patients (11.5 +/- 1.9 vs. 1.8 +/- 1.1, p = 0.0012).<br />Conclusions: Intraoperative TCD detected cerebral ischaemia and yielded no false-negative. An mMCAv of 10 cm/s or less may indicate the risk of clamping ischaemia better than the higher threshold currently proposed. This would avoid unnecessary shunting due to false-positives.
- Subjects :
- Aged
Anesthesia, Local
Blood Flow Velocity physiology
Brain diagnostic imaging
Carotid Artery, Internal surgery
Carotid Stenosis diagnosis
Electroencephalography
Female
Humans
Intraoperative Period
Male
Middle Aged
Monitoring, Physiologic
Nerve Block
Predictive Value of Tests
Carotid Stenosis surgery
Cerebral Arteries diagnostic imaging
Endarterectomy
Ischemic Attack, Transient diagnostic imaging
Ultrasonography, Doppler, Transcranial
Subjects
Details
- Language :
- English
- ISSN :
- 1078-5884
- Volume :
- 12
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 8980427
- Full Text :
- https://doi.org/10.1016/s1078-5884(96)80004-9