CAROTID ANGIOPLASTY AND STENTING - WILL PERIPROCEDURAL TRANSCRANIAL DOPPLER MONITORING BE IMPORTANT

Purpose: To explore the value of transcranial Doppler (TCD) ultrasonog raphy in the periprocedural monitoring of patients undergoing angiopla sty procedures for stenosis of the internal carotid artery. Methods: T hirty-two patients were included in the study between April 1991 and S eptember 1995 (6 females, 26 males; average age 66 years). All patient s were interrogated before and after angioplasty by a standard TCD exa mination protocol. Intraprocedurally, TCD was used continuously to mon itor cerebral blood flow and supply evidence of embolic particulates. Nineteen patients were treated by percutaneous transluminal angioplast y (PTA) alone; the other 13 underwent primary stent (PS) implantation. Results: High-intensity transient signals indicative of emboli appear ed to be more frequent in the PTA group than in the PS cohort. Preoper ative TCD identified 3 (9%) high-risk patients with incompetent collat eral pathways through the circle of Willis. Intraoperatively, TCD dete cted two postdilation carotid occlusions, a sylvian embolism, and one case of arterial spasm. The preprocedural TCD in a patient with contra lateral carotid occlusion showed good collateral circulation, providin g reassurance during conversion to endarterectomy when an undeployed s tent obstructed blood flow. Postoperatively, TCD confirmed restored in tracerebral circulation and identified one hyperperfusion syndrome. Co nclusions: TCD is a simple, relatively inexpensive examination that ca n preprocedurally identify carotid stenosis patients at high risk for intraoperative cerebral ischemia in whom PTA might be preferable to su rgery. During the procedure, TCD can document the benefits of endovasc ular treatment and offer early detection of ischemic complications.