Intraoperative transcranial Doppler sonography monitoring during carotid surgery under locoregional anaesthesia

M. F. Giannoni, E. Sbarigia, M. A. Panico, F. Speziale, M. Antonini, C. Maraglino, P. Fiorani

Research output: Contribution to journalArticlepeer-review

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. 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.

Original languageEnglish
Pages (from-to)407-411
Number of pages5
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume12
Issue number4
DOIs
Publication statusPublished - 1996

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Surgery

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