Transcranial Doppler assessment of cerebral collateral during carotid endarterectomy

Sixteen patients (mean age 59 +/- 9 years) who were to undergo carotid endarterectomy were examined pre- and peroperatively using pulsed Doppler-shifted ultrasound; blood velocities in the middle cerebral artery were measured before and during common carotid compression in the conscious patient, and before and during measurement of carotid stump pressures at surgery in the anaesthetized patient. Measurements at endarterectomy showed a significant difference in middle cerebral artery blood velocities from patients with stump pressures of greater and less than 50 mmHg (t = 4.0, P less than 0.005). A threshold of 10 cm s-1 distinguished between stump pressures of greater and less than 50 mmHg in 15 of the 16 patients. Pre-operative blood velocity measurements during carotid compression did not correlate with those taken peroperatively at carotid clamping.