TY - JOUR
T1 - Intraoperative transcranial Doppler sonography monitoring during carotid surgery under locoregional anaesthesia
AU - Giannoni, M. F.
AU - Sbarigia, E.
AU - Panico, M. A.
AU - Speziale, F.
AU - Antonini, M.
AU - Maraglino, C.
AU - Fiorani, P.
PY - 1996
Y1 - 1996
N2 - 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. Materials and methods: In a consecutive series of 57 patients undergoing carotid endarterectomy under locoregional anaesthesia 52 were monitored by intraoperative TCD, continuous EEG, and neurologic awake testing. 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). 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.
AB - 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. Materials and methods: In a consecutive series of 57 patients undergoing carotid endarterectomy under locoregional anaesthesia 52 were monitored by intraoperative TCD, continuous EEG, and neurologic awake testing. 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). 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.
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U2 - 10.1016/S1078-5884(96)80004-9
DO - 10.1016/S1078-5884(96)80004-9
M3 - Article
C2 - 8980427
AN - SCOPUS:0030451325
VL - 12
SP - 407
EP - 411
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
SN - 1078-5884
IS - 4
ER -