COMBINED TRANSCRANIAL DOPPLER AND ELECTROPHYSIOLOGIC MONITORING FOR CAROTID ENDARTERECTOMY

The results of carotid endarterectomy can be improved by reducing the perioperative embolic and hemodynamic risks. Electrophysiologic monito ring, although reliable, cannot provide full information. In this stud y, we report on the combined use of transcranial Doppler (TCD) and ele ctrophysiologic monitoring in 153 patients undergoing 166 carotid enda rterectomy procedures. TCD monitoring confirmed the low incidence of i ntolerance to crossclamp (1.8%), showing a good correlation with elect rophysiologic monitoring. In addition, it frequently showed embolic si gnals immediately after clamp release, but never during carotid dissec tion or in the final operative phases. Furthermore, TCD allowed the de tection of hyperperfusional flow patterns in four cases, making immedi ate and aggressive control of arterial pressure possible.