Intraoperative Monitoring of Cerebral Blood Flow and Metabolism Using Transcranial Doppler and Transcranial Near-infrared Spectrometry during Carotid Endarterectomy Followed by Sudden Cardiac Arrest and Cardiopulmonary Resuscitation: A Case Report

Yasukazu Katakura; Toshiyuki MURAKAMI; Kenya Miyoshi; Kenji YOSHIDA; Masakazu Kobayashi; Shunrou Fujiwara; Kuniaki OGASAWARA; Yosuke AKAMATSU

doi:10.2335/scs.54.38

January 1, 2026Surgery for Cerebral StrokeOpen Access

Intraoperative Monitoring of Cerebral Blood Flow and Metabolism Using Transcranial Doppler and Transcranial Near-infrared Spectrometry during Carotid Endarterectomy Followed by Sudden Cardiac Arrest and Cardiopulmonary Resuscitation: A Case Report

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Key Points

The aim is to report the monitoring of cerebral blood flow and metabolism during a carotid endarterectomy that experienced cardiac arrest.
Utilized transcranial doppler to assess mean flow velocity of the middle cerebral artery.
Measured brain oxygen saturation using transcranial near-infrared spectrometry.
Collected data before, during, and after the occurrence of cardiac arrest.
Cardiac arrest occurred with a subsequent drop in mean flow velocity and oxygen saturation following carotid clamping release.
During cardiopulmonary resuscitation, mean flow velocity temporarily increased in response to chest compressions.
Post-resuscitation, blood pressure and mean flow velocity significantly increased, indicating possible disautoregulation.

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Implication

Case report highlights intraoperative monitoring of brain blood flow during cardiac arrest, suggesting potential interventions.

Abstract

経頭蓋ドプラ（TCD）で中大脳動脈血流速度および経頭蓋近赤外線スペクトロスコピー（NIRS）で脳表酸素飽和度測定下の頚動脈内膜剝離術（CEA）中に心停止をきたし心肺蘇生中の脳循環代謝モニタリングを行えた1例を報告する．症例は高血圧と糖尿病の既往のある61歳，男性．脳ドックで無症候性左内頚動脈高度狭窄を指摘され，左CEAを行う方針とした．術前の冠動脈を含めた心機能精査では，異常を指摘されなかった．全身麻酔導入後から頚動脈遮断解除直後までは問題なく経過したが，頚動脈遮断解除2分後より心室性頻脈となり，収縮期血圧が低下した．その間，左側middle cerebral artery-mean flow velocity（MCA-MFV）および脳表酸素飽和度（rSO2）は体血圧と同期して低下したが，NIRSで測定されたDeOxi-HbIは上昇した．その後，心室細動に移行したため心肺蘇生処置を行ったところ，MCA-MFVは心臓マッサージに同期して一時的に上昇が認められ，rSO2は低下し，Total-HbIおよびDeOxi-HbIは上昇した．自己心拍再開後，体血圧は180/120mmHgへ上昇し，左側MCA-MFVは前値の2倍以上となり，rSO2上昇を認めdisautoregulationを示唆する所見であった．

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Cite This Study

Katakura et al. (2026) studied this question.

synapsesocial.com/papers/69d34d5c9c07852e0af974b3 https://doi.org/10.2335/scs.54.38

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Intraoperative Monitoring of Cerebral Blood Flow and Metabolism Using Transcranial Doppler and Transcranial Near-infrared Spectrometry during Carotid Endarterectomy Followed by Sudden Cardiac Arrest and Cardiopulmonary Resuscitation: A Case Report

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Intraoperative Monitoring of Cerebral Blood Flow and Metabolism Using Transcranial Doppler and Transcranial Near-infrared Spectrometry during Carotid Endarterectomy Followed by Sudden Cardiac Arrest and Cardiopulmonary Resuscitation: A Case Report

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