title: Perioperative transorbital Doppler flow imaging offers an alternative to transcranial Doppler monitoring in those patients without a temporal bone acoustic window.
abstract: Transcranial Doppler has been used to identify microembolic signals before, during and after carotid endarterectomy, but 10% to 15% of patients are reported not to have suitable temporal bone window. The aim of this study was to assess the feasibility of transorbital Doppler monitoring of patients with absent temporal bone acoustic window. Between 2005 and 2008, those patients with absent temporal bone acoustic window were assessed for a transorbital acoustic window. During the study period, 318 carotid endarterectomy were performed. In the 29 (9.1%) with absent temporal bone acoustic window, 25 (86%) had satisfactory transorbital acoustic windows, consequently only four (1.2%) of patients could not be monitored postoperatively. One patient required postoperative transorbital acoustic windows directed glycoprotein IIb/IIIa receptor antagonist infusion due to excessive carotid microembolisation to prevent stroke. This is the first description of the use of transorbital flow imaging to determine postoperative cerebral blood flow, microembolic load and to direct the use of intravenous antiplatelet agents.
authors: Coventry and Warwickshire County Vascular Unit, Warwick Medical School, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom.
authors: Tony S
authors: TS
authors: Jaipersad
authors: Mahmud
authors: M
authors: Saedon
authors: Carl
authors: C
authors: Tiivas
authors: Collette
authors: C
authors: Marshall
authors: Dan J
authors: DJ
authors: Higman
authors: Christopher H E
authors: CH
authors: Imray
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D001921:Brain / Q000098:blood supply; D002560:Cerebrovascular Circulation; D016894:Endarterectomy, Carotid / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000098:blood supply* / Q000000981:diagnostic imaging*; D059035:Perioperative Period; D012189:Retrospective Studies; D013701:Temporal Bone / Q000000981:diagnostic imaging*; D017585:Ultrasonography, Doppler, Transcranial