Abstract
Intraoperative transcranial Doppler monitoring of cerebral ischemia during carotid clamping under general anesthesia was done in 238 carotid artery operations, mostly endarterectomy. Depending on the severity of reduction of middle cerebral artery mean velocity, patients were classified as no, mild, or severe ischemia at clamping. With a carotid shunt, velocity was always in the "no ischemia" category during shunting. For patients with no ischemia, stroke was significantly lower without a shunt (2/175 no shunt versus 2/12 shunt). For mild ischemia, shunting did not affect the stroke rate (1/20 no shunt versus 0/9 shunt). For severe ischemia, strokes were less frequent with a shunt (4/9 no shunt versus 0/13 shunt). Intraoperative electroencephalogram predicted most, but not all severely ischemic cases. Carotid back pressure correlated with Doppler velocity, but transcranial Doppler was more helpful. Transcranial Doppler is a new and valuable technique in carotid surgery.
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Selected References
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- Easton J. D., Sherman D. G. Stroke and mortality rate in carotid endarterectomy: 228 consecutive operations. Stroke. 1977 Sep-Oct;8(5):565–568. doi: 10.1161/01.str.8.5.565. [DOI] [PubMed] [Google Scholar]
- Green R. M., Messick W. J., Ricotta J. J., Charlton M. H., Satran R., McBride M. M., DeWeese J. A. Benefits, shortcomings, and costs of EEG monitoring. Ann Surg. 1985 Jun;201(6):785–792. doi: 10.1097/00000658-198506000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Halsey J. H. Effect of emitted power on waveform intensity in transcranial Doppler. Stroke. 1990 Nov;21(11):1573–1578. doi: 10.1161/01.str.21.11.1573. [DOI] [PubMed] [Google Scholar]
- Halsey J. H., McDowell H. A., Gelmon S., Morawetz R. B. Blood velocity in the middle cerebral artery and regional cerebral blood flow during carotid endarterectomy. Stroke. 1989 Jan;20(1):53–58. doi: 10.1161/01.str.20.1.53. [DOI] [PubMed] [Google Scholar]
- Hertzer N. R., Beven E. G. A retrospective comparison of the use of shunts during carotid endarterectomy. Surg Gynecol Obstet. 1980 Jul;151(1):81–84. [PubMed] [Google Scholar]
- Morawetz R. B., Zeiger H. E., McDowell H. A., Jr, McKay R. D., Varner P. D., Gelman S., Halsey J. H. Correlation of cerebral blood flow and EEG during carotid occlusion for endarterectomy (without shunting) and neurologic outcome. Surgery. 1984 Aug;96(2):184–189. [PubMed] [Google Scholar]
- Sundt T. M., Jr, Ebersold M. J., Sharbrough F. W., Piepgras D. G., Marsh W. R., Messick J. M., Jr The risk-benefit ratio of intraoperative shunting during carotid endarterectomy. Relevancy to operative and postoperative results and complications. Ann Surg. 1986 Feb;203(2):196–204. doi: 10.1097/00000658-198602000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]