Cerebral vasoreactivity does not predict cerebral ischaemia during carotid endarterectomy.
OBJECTIVE
Assessment of cerebrovasoreactivity (CVR), obtained by transcranial Doppler (TCD) and the acetazolamide test to predict cases requiring selective carotid shunting on the basis of neurologic monitoring.


METHODS
A consecutive series of 87 carotid endarterectomy (CEA) cases was studied. Before surgery CVR was evaluated by measuring the mean velocity of the middle cerebral artery (mvMCA) using TCD at the basal condition and at 30 min after intravenous administration of acetazolamide (1 g). Carotid shunting was performed using neurologic monitoring under local anesthesia. Receiver operating characteristic (ROC) curve was calculated for sensitivity and specificity for various CVR cut offs.


RESULTS
The ROC curve demonstrated that there was no single CVR cut off with both sensitivity and specificity above 80%.


CONCLUSIONS
The present study, which employed neurologic monitoring as the method of comparison, did not prove that CVR, as calculated by TCD and the acetazolamide test, is a valid preoperative test for predicting cerebral ischaemia caused by carotid clamping.
Belardi
P
P
Department of Vascular Surgery, University of Genoa, Genoa, Italy.
Lucertini
G
G
D000086:Acetazolamide; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000502:physiology; D016343:Monitoring, Intraoperative / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D017585:Ultrasonography, Doppler, Transcranial
D000086:Acetazolamide