title: Prediction of cerebral hyperperfusion after carotid endarterectomy with transcranial Doppler.
abstract: OBJECTIVE
  To determine the diagnostic value for predicting cerebral hyperperfusion syndrome (CHS) by adding a transcranial Doppler (TCD) measurement in the early postoperative phase after carotid endarterectomy (CEA).
  
  
  METHODS
  Patients who underwent carotid endarterectomy between January 2004 and August 2010 and in whom both intra- and postoperative TCD monitoring were performed were included.
  
  
  METHODS
  In 184 CEA patients the mean velocity (V(mean)) preoperatively (V1), pre-clamping (V2), post-declamping (V3) and postoperatively (V4) was measured using TCD. The intra-operative V(mean) increase ((V3 - V2)/V2) was compared to the postoperative increase ((V4 - V1)/V1) in relation to CHS. CHS was diagnosed if the patient developed neurological complaints in the presence of a preoperative V(mean) increase >100%.
  
  
  RESULTS
  Sixteen patients (9%) had an intra-operative V(mean) increase >100% and 22 patients (12%) a postoperative V(mean) increase of >100%. In 10 patients (5%) CHS was diagnosed; two of those had an intra-operative V(mean) increase of >100% and nine postoperative V(mean) increase >100%. This results in a positive predictive value of 13% for the intra-operative and 41% for the postoperative measurement.
  
  
  CONCLUSIONS
  Besides the commonly used intra-operative TCD monitoring additional TCD measurement in the early postoperative phase is useful to more accurately predict CHS after CEA.
authors.affiliation: Department of Vascular Surgery (G04.129), University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: C W A
authors.initials: CW
authors.lastname: Pennekamp
authors.forename: S C
authors.initials: SC
authors.lastname: Tromp
authors.forename: R G A
authors.initials: RG
authors.lastname: Ackerstaff
authors.forename: M L
authors.initials: ML
authors.lastname: Bots
authors.forename: R V
authors.initials: RV
authors.lastname: Immink
authors.forename: W
authors.initials: W
authors.lastname: Spiering
authors.forename: J P P M
authors.initials: JP
authors.lastname: de Vries
authors.forename: L J
authors.initials: LJ
authors.lastname: Kappelle
authors.forename: F L
authors.initials: FL
authors.lastname: Moll
authors.forename: W F
authors.initials: WF
authors.lastname: Buhre
authors.forename: G J
authors.initials: GJ
authors.lastname: de Borst
mesh_terms: D000368:Aged; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000209:etiology*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D017585:Ultrasonography, Doppler, Transcranial