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Continuous transcranial Doppler ultrasonography and electroencephalography during carotid endarterectomy: A multimodal monitoring system to detect intraoperative ischemia

  • Papers From The Peripheral Vascular Surgery Society
  • Published:
Annals of Vascular Surgery

Abstract

Transcranial Doppler ultrasonography (TCD) and EEG monitoring during carotid endarterectomy provide continuous information on the electrical activity of the cerebral cortex, blood flow velocities in the ipsilateral middle cerebral artery, and the occurrence of microemboli. One hundred thirty carotid endarterectomies performed with TCD and EEG monitoring were studied prospectively. During cross-clamping of the carotid artery a high correlation was found between EEG asymmetry and reduction of blood flow velocity in the middle cerebral artery (p<10−6, Student'st test). Microemboli were detected in 80 patients during the operation. Although not statistically significant, this occurrence of microemboli was associated with signs and symptoms of intraoperative ischemia (p=0.08, Fisher's exact test). In comparison with earlier studies, a tendency toward intraoperative stroke reduction was noted. Only one nondisabling intraoperative stroke occurred (0.8%). In addition to the EEG, TCD monitoring of hemodynamic changes and microemboli in the middle cerebral artery provides important information to the surgeon instantaneously. TCD monitoring of blood flow velocities and embolism during carotid endarterectomy may help to reduce the number and gravity of intraoperative stroke.

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Authors and Affiliations

  1. Department of Clinical Neurophysiology Vascular Surgery, St. Antonius Hospital, Nieuwegein (Utrecht), The Netherlands

    Frans L. Moll MD, PhD & Freddie E. E. Vermeulen MD

  2. Department of Clinical Neurophysiology Neurology, St. Antonius Hospital, Nieuwegein (Ultrecht), The Netherlands

    Johanna M. P. I. van Haelst MD

  3. Department of Clinical Neurophysiology, St. Antonius Hospital, PB 2500, 3430 EM, Nieuwegein (Utrecht), The Netherlands

    Cees Jansen MD & Rob G. A. Ackerstaff MD, PhD

Authors
  1. Cees Jansen MD
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  2. Frans L. Moll MD, PhD
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  3. Freddie E. E. Vermeulen MD
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  4. Johanna M. P. I. van Haelst MD
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  5. Rob G. A. Ackerstaff MD, PhD
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Jansen, C., Moll, F.L., Vermeulen, F.E.E. et al. Continuous transcranial Doppler ultrasonography and electroencephalography during carotid endarterectomy: A multimodal monitoring system to detect intraoperative ischemia. Annals of Vascular Surgery 7, 95–101 (1993). https://doi.org/10.1007/BF02042666

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  • DOI: https://doi.org/10.1007/BF02042666

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