Key result
TCD detects reduced flow predicting neurologic changes in 3 CEA patients while EEG remains unchanged.
Why the study?
Does transcranial Doppler ultrasonography predict cerebral injury better than electroencephalography during carotid endarterectomy?
Case Report (n=3)
Does transcranial Doppler ultrasonography predict cerebral injury better than electroencephalography during carotid endarterectomy?
Transcranial Doppler ultrasonography may be more sensitive than electroencephalography for detecting clinically significant reductions in cerebral blood flow during carotid endarterectomy clamping.
TCD may detect hypoperfusion missed by EEG in CEA; case reports leave open any monitoring superiority and should not change practice.
When shunts are selectively used during carotid endarterectomy, the adequacy of collateral cerebral blood flow (CBF) after the carotid artery is clamped is determined by monitors based on different physiologic measurements. In this series of three patients, we used electroencephalography (EEG) to measure neuronal electrical activity and transcranial Doppler ultrasonography (TCD) to measure CBF velocity. In each of our cases, the EEG was unchanged from preclamp values, while TCD CBF velocity was dramatically reduced. All three patients had transient neuropsychometric or neurologic changes after surgery, which resolved.
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Costin et al. (2002) conducted a case report in Carotid endarterectomy (n=3). Transcranial Doppler ultrasonography (TCD) and electroencephalography (EEG) was evaluated on Transient neuropsychometric or neurologic changes. Transcranial Doppler ultrasonography detected reduced cerebral blood flow velocity predicting transient neurologic changes in 3 patients during carotid endarterectomy, whereas EEG remained unchanged.
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