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Preoperative cerebral hemodynamics and shunting during carotid endarterectomy in patients with severe unilateral carotid stenosis
Author(s) -
Telman Gregory,
Kouperberg Efim,
Nitecki Sami,
Karram Toni,
Schwarz Henry A.,
Sprecher Elliot,
Hoffman Aaron,
Yarnitsky David
Publication year - 2007
Publication title -
journal of clinical ultrasound
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.272
H-Index - 61
eISSN - 1097-0096
pISSN - 0091-2751
DOI - 10.1002/jcu.20354
Subject(s) - medicine , shunting , carotid endarterectomy , stenosis , transcranial doppler , middle cerebral artery , cardiology , hemodynamics , anterior cerebral artery , endarterectomy , shunt (medical) , ischemia
Purpose. To estimate the possible predictors for the need for shunting during carotid endarterectomy in patients with severe unilateral carotid stenosis based on preoperative transcranial Doppler sonographic examination. Materials and Methods. One hundred twenty‐six patients were included in the study. Pulsatility index, flow acceleration, peak systolic velocity, and mean velocity were measured in the middle cerebral artery (MCA) and anterior cerebral artery on both sides. Cerebrovascular reactivity (CVR) was evaluated in 21 patients with shunts and in 55 patients without shunts. Results. The shunted and nonshunted groups did not differ with regard to demographic and clinical characteristics. The side‐to‐side difference in peak systolic velocity and mean velocity of the MCA was significantly higher in patients with shunts. CVR were significantly higher in the patients without shunts (36.0 ± 17.2%) than in patients with shunts (16.6 ± 11.4%; p = 0.0003). The peak systolic velocity and mean velocity asymmetry of the MCA had relatively low receiver operating characteristics, whereas CVR exhibited a relatively high accuracy in predicting the need for shunting. Conclusion. Low CVR and increased asymmetry of MCA velocities were found in patients who subsequently required shunting during carotid endarterectomy. The relatively low accuracy of the MCA asymmetry should prevent the use of this criterion as a reliable preoperative predictor for shunting during carotid surgery, whereas CVR was more accurate and may prove useful in this setting. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2007