Role of Doppler Ultrasound Analysis of Blood Flow Through the Ophthalmic and Intracranial Arteries in Predicting Neurologic Symptoms During Carotid Endarterectomy
| Autor: | Stjepan Aždajić, Björn Dario Franjić, Jasmina Hranjec, Ivo Lovričević, Petar Brkić, Duško Dobrota |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Ultrasonography Doppler Transcranial medicine.medical_treatment Carotid endarterectomy blood flow carotid artery carotid endarterectomy ophthalmic artery transcranial Doppler vascular surgery medicine.artery Internal medicine Anterior cerebral artery Humans Medicine Carotid Stenosis Radiology Nuclear Medicine and imaging Stroke Endarterectomy Carotid Radiological and Ultrasound Technology business.industry Hemodynamics Intracranial Artery medicine.disease Transcranial Doppler Stenosis Cerebrovascular Circulation Ophthalmic artery Cardiology Internal carotid artery business Blood Flow Velocity Carotid Artery Internal |
| Zdroj: | Journal of Ultrasound in Medicine. 40:2141-2156 |
| ISSN: | 1550-9613 0278-4297 |
| DOI: | 10.1002/jum.15599 |
| Popis: | Objectives— Carotid endarterectomy (CEA) is frequently performed under locoregional anesthesia. The intraoperative clamping of the internal carotid artery (ICA) leads to cerebral hypoperfusion, which may in some patients result in the development of neurologic symptoms (NS). The objective of our study was to investigate whether there is an association between the preoperative ultrasound (US) Doppler flow in the ophthalmic artery (OA) and intracranial artery and the occurrence of these intraoperative NS. Methods— We compared 50 patients with NS and 150 patients without NS during CEA. We analyzed their preoperative blood flow characteristics by Doppler US and their clinical and demographic characteristics. Results— The contralateral ICA occlusion increased the likelihood of intraoperative NS (odds ratio [OR], 8.4 ; P < .001). Abnormal contralateral OA flow also increased the likelihood of NS (OR, 1.84 ; P < .001), whereas ipsilateral abnormal OA flow reduced it (OR, 0.73 ; P = .06). Increased flow in the ipsilateral anterior cerebral artery (ACA) increased the likelihood of NS (OR, 3.3), whereas reversed flow decreased it (OR, 0.1 ; P = .03). Inverse flow in the contralateral ACA increased the risk (OR, 5.4), whereas increased flow reduced it (OR, 0.2 ; P = .02). Male patients had a higher risk of NS (P = .09) as well as older patients (P = .05). Eight percent of the patients with NS developed a transient ischemic attack or stroke. Conclusions— Doppler US analysis of the OA and ACA in combination with analysis of ICA stenosis may be a promising predictor of NS during ICA clamping. This, in turn, may warn the patient and the surgeon of an increased risk during surgery. |
| Databáze: | OpenAIRE |
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