Ann Surg Treat Res.  2017 Feb;92(2):105-109. 10.4174/astr.2017.92.2.105.

Cerebral monitoring during carotid endarterectomy by transcranial Doppler ultrasonography

• Yun WS

• KMID: 2367923
• DOI: http://doi.org/10.4174/astr.2017.92.2.105

Abstract

PURPOSE
To evaluate the efficacy and safety of cerebral monitoring by transcranial Doppler ultrasonography (TCD) for the detection of cerebral ischemia during carotid endarterectomy (CEA).
METHODS
From August 2004 to December 2013, 159 CEAs were performed in a tertiary hospital. All procedures were performed under general anesthesia. Intraoperative TCD was routinely used to detect cerebral ischemia. Of the 159 patients, 102 patients were included in this study, excluding 27 patients who had a poor transtemporal isonation window and 30 patients who used additional cerebral monitoring systems such as electroencephalography or somatosensory evoked potentials. When mean flow velocity in the ipsilateral middle cerebral artery decreased by >50% versus baseline during carotid clamping carotid shunting was selectively performed. The carotid shunt rate and incidence of perioperative (<30 days) stroke or death were investigated by reviewing medical records.
RESULTS
Carotid shunting was performed in 31 of the 102 patients (30%). Perioperative stroke occurred in 2 patients (2%); a minor ischemic stroke caused by embolism in one and an intracerebral hemorrhage in the other. Perioperative death developed in the latter patient.
CONCLUSION
TCD is a safe cerebral monitoring tool to detect cerebral ischemia during CEA. It can reduce use of carotid shunt.

Keyword

Carotid endarterectomy; Transcranial Doppler ultrasonography

MeSH Terms

Anesthesia, General
Brain Ischemia
Cerebral Hemorrhage
Constriction
Electroencephalography
Embolism
Endarterectomy, Carotid*
Evoked Potentials, Somatosensory
Humans
Incidence
Medical Records
Middle Cerebral Artery
Stroke
Tertiary Care Centers
Ultrasonography, Doppler, Transcranial*

Figure

• 

  Fig. 1 Intraoperative transcranial Doppler (TCD) monitoring. (A) A hands-free standard 2-MHz pulsed wave TCD transducer was positioned on the ipsilateral temporal bone window with head frame. Mean flow velocity of the ipsilateral middle cerebral artery (MCA) was measured before (B) and after (C) carotid clamping.

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