CLINICAL RELEVANCE OF INTRAOPERATIVE EMBOLIZATION DETECTED BY TRANSCRANIAL DOPPLER ULTRASONOGRAPHY DURING CAROTID ENDARTERECTOMY - A PROSPECTIVE-STUDY OF 100 PATIENTS

A study was performed to investigate the clinical significance of micr oembolization detected by transcranial Doppler ultrasonography (TCD) b y determining the quantity and character of emboli and correlating the se with neurological and psychometric outcome, fundoscopy, automated v isual field testing and computed tomographic brain scans in 100 consec utive patients undergoing carotid endarterectomy. Embolization was det ected in 92 per cent of successfully monitored operations. Most emboli were characteristic of air and not associated with adverse clinical o utcome. However, more than ten particulate emboli during initial carot id dissection correlated with a significant deterioration in postopera tive cognitive function. A relationship between persistent particulate embolization in the immediate postoperative period, and both incipien t carotid artery thrombosis and the development of major neurological deficits was observed. Immediate intervention, based on TCD evidence o f embolization, has the potential to avert neurological deficits resul ting from particulate embolization.