title: Temporary occlusion of middle cerebral artery by macroembolism in carotid surgery.
abstract: Two patients are presented who during carotid endarterectomy (CEA) temporarily showed an obstruction of the middle cerebral artery (MCA) mainstem by a macroembolus resulting in cerebral ischaemia. Both cases are unusual examples of CEA and selected from a cohort of more than 1,500 operations. During surgery with general anaesthesia, brain function was monitored with computerized electroencephalography (EEG) and transcranial Doppler (TCD) ultrasonography. The simultaneous use of EEG and TCD monitoring allowed us to witness the development of intraoperative cerebral ischaemia and to relate these events to a temporary occlusion of the MCA mainstem by a macroembolus. This is the first life report that describes obstruction of a cerebral artery by arterial embolism resulting in cerebral ischaemia.
authors.affiliation: Department of Neurology, St. Antonius Hospital, Nieuwegein (Utrecht), and University Hospital Utrecht, The Netherlands.
authors.forename: S P
authors.initials: SP
authors.lastname: Claus
authors.forename: E S
authors.initials: ES
authors.lastname: Louwerse
authors.forename: H W
authors.initials: HW
authors.lastname: Mauser
authors.forename: M
authors.initials: M
authors.lastname: van der Mee
authors.forename: F L
authors.initials: FL
authors.lastname: Moll
authors.forename: W H
authors.initials: WH
authors.lastname: Mess
authors.forename: R G
authors.initials: RG
authors.lastname: Ackerstaff
mesh_terms: D002545:Brain Ischemia / Q000209:etiology*; D004569:Electroencephalography; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications* / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D017585:Ultrasonography, Doppler, Transcranial