The use of preoperative transcranial Doppler variables to predict which patients do not need a shunt during carotid endarterectomy.
OBJECTIVE
to analyse whether preoperative transcranial Doppler (TCD) variables can predict intraoperative shunt requirement.


METHODS
the blood-flow velocity (BFV) in the major basal cerebral arteries was measured preoperatively with TCD, in 178 patients scheduled for CEA. Carotid artery compression and CO2 reactivity tests were also performed. Intraoperative electroencephalography was used to decide whether a shunt was needed. Differences in the probability of shunt requirement between the categories of variables were assessed with crosstabs statistics.


RESULTS
preoperative TCD criteria clearly identified a subgroup of 59 patients (33%) who did not require a shunt. In general, these patients appeared to have adequate collateral flow through the anterior communicating artery. In contrast, prediction of the need for a shunt was less reliable. TCD variables could predict the need for a shunt with a probability of only 60%.


CONCLUSIONS
preoperative TCD can be used to identify patients who do not require a shunt during carotid endarterectomy.
Visser
G H
GH
Department of Clinical Neurophysiology, University Hospital Rotterdam, The Netherlands.
Wieneke
G H
GH
van Huffelen
A C
AC
Eikelboom
B C
BC
D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D002245:Carbon Dioxide; D016893:Carotid Stenosis / Q000503:physiopathology / Q000601:surgery; D002536:Cerebral Arteries / Q000503:physiopathology / Q000601:surgery; D002560:Cerebrovascular Circulation / Q000502:physiology*; D016009:Chi-Square Distribution; D003097:Collateral Circulation / Q000502:physiology; D004569:Electroencephalography; D016894:Endarterectomy, Carotid; D005260:Female; D005544:Forecasting; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications; D011300:Preoperative Care; D011312:Pressure; D011336:Probability; D015203:Reproducibility of Results; D020521:Stroke / Q000209:etiology; D017585:Ultrasonography, Doppler, Transcranial
D002245:Carbon Dioxide