Transcranial Doppler Monitoring During Carotid Endarterectomy Helps to Identify Patients at Risk of Postoperative Hyperperfusion

Objectives: to investigate whether transcranial Doppler (TCD) monitoring can identify patients at risk of hyperperfusion, and whether active postoperative treatment of selected patients decreases the risk of intracerebral haemorrhage (ICH). Design: a case cohort study of 688 patients undergoing caro...

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Bibliographic Details
Published in:European journal of vascular and endovascular surgery 1999-09, Vol.18 (3), p.222-227
Main Authors: Dalman, JE, Beenakkers, ICM, Moll, FL, Leusink, JA, Ackerstaff, RGA
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Blood Flow Velocity - physiology
Brain Edema - diagnostic imaging
Carotid endarterectomy
Carotid Stenosis - diagnostic imaging
Carotid Stenosis - surgery
Cerebral Hemorrhage - diagnostic imaging
Endarterectomy, Carotid
Female
Humans
Hyperemia - diagnostic imaging
Hyperperfusion syndrome
Intracranial Hypertension - diagnostic imaging
IntraÍcerebral haemorrhage
Male
Middle Aged
Monitoring, Intraoperative
Perioperative monitoring
Postoperative Complications - diagnostic imaging
Prognosis
Pulsatile Flow - physiology
Risk
Transcranial Doppler
Ultrasonography, Doppler, Transcranial
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Summary:Objectives: to investigate whether transcranial Doppler (TCD) monitoring can identify patients at risk of hyperperfusion, and whether active postoperative treatment of selected patients decreases the risk of intracerebral haemorrhage (ICH). Design: a case cohort study of 688 patients undergoing carotid endarterectomy (CEA) with intraoperative TCD monitoring. Methods: sixty-two patients (9%) fulfilled the TCD criteria for hyperperfusion, i.e. >100% increase of peak blood flow velocity or pulsatility index of the middle cerebral artery, compared to preclamp baseline values. In these patients, blood pressure was closely monitored and controlled postoperatively. Results: postoperatively, seven of these patients (11%) exhibited clinical signs or symptoms of hyperperfusion but no cerebral haemorrhage (ICH). This is a significantly better outcome (p
ISSN:1078-5884
1532-2165
DOI:10.1053/ejvs.1999.0846