Transcranial doppler in carotid endarterectomy / 中华神经医学杂志

ABSTRACT

Objective To explore the application value oftranscranial doppler (TCD) in carotid endarterectomy (CEA) through monitoring the hemodynamic changes of intracranial arteries during the perioperative period.Methods Eighty-two patients with internal carotid artery stenosis (ICAS),admitted to our hospital from January 2012-January 2013,were chosen in our study.Preoperative,intraoperative and postoperative TCD evaluations on these patients accepted CEA were performed; degrees of artery stenosis and fluency of lateral branch of the patients before CEA were evaluated; microembolic signals (MESs) and hemodynamics of the middle cerebral artery (MCA) in the surgery side were monitored during the perioperative period; the MCA velocity (VMCA) and the states of collateral circulation were observed after CEA.Results All 82 patients showed severe ICAS,low blood VMCA and low pulsatility index of MCA; anterior and posterior communicating branch did not exist in 6 patients; the other 76 patients showed different status of communicating artery.MESs were captured immediately after opening the clamp of common carotid artery (CCA) in 31 patients; when the ipsilateral CCA was clamped,2 patients showed a rapidly decreased VMCA to 0 cm/s,and a vascular shunt was used to ensure the brain blood supply.About 93.9％ patients presented an increase in the blood velocity and pulsatility index ofipsilateral MCA,together with a subsequent close of collateral circulation; over 1.5 times increase of VMCA was observed in about 24.7％ patients.Acute cerebral infarction in one patient occurred on the same day of CEA.Conclusions TCD could assess the hemodynamics of the contralateral MCA and the closure of collateral communication,thus,helping us predict the hyperperfusion and analyze the pathogenesis of cerebral infarction during perioperative CEA.