Ultrasound turbulence index during thromboendarterectomy predicts postoperative cerebral microembolism.
BACKGROUND
Cerebral microembolic signals (MES) after carotid endarterectomy (CEA) are associated with an increased risk of postoperative stroke. We investigated the relationship of an intraoperatively recorded ultrasound turbulence index (TI) during CEA and the occurrence of MES.


METHODS
Short-time MES detection was performed on 164 patients (mean age 64 years, 140 males) in the ipsilateral middle cerebral artery within 2 h after CEA. A specialized continuous-wave ultrasound Doppler probe measured the TI within the reconstructed internal carotid artery during surgery.


RESULTS
The occurrence of postoperative MES increased significantly with the TI: a TI >26 predicted MES with a sensitivity of 72% and a specificity of 76%. The MES rate and TI were higher in patients operated with the eversion technique than in patients operated with the patch technique (p = 0.005). There was no relationship with preoperative MES, site of surgery or age of patients. Female patients had a higher risk of postoperative MES than males (p = 0.003).


CONCLUSIONS
Simplified intraoperative Doppler sonography or short-time MES detection after CEA are feasible, and may be helpful for surgical quality control and decision making (e.g. treatment with platelet antagonists).
Brosig
Torge
T
Department of Neurology, Heinrich Heine University Dusseldorf, Dusseldorf, Germany.
Hoinkes
Annika
A
Seitz
Rudiger J
RJ
Sandmann
Wilhelm
W
Huber
Rita
R
Siebler
Mario
M
D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology; D013997:Time Factors; D018608:Ultrasonography, Doppler; D017585:Ultrasonography, Doppler, Transcranial; D018084:Ultrasonography, Interventional