EXPERIENCE WITH TRANSCRANIAL DOPPLER MONITORING REDUCES THE INCIDENCEOF PARTICULATE EMBOLIZATION DURING CAROTID ENDARTERECTOMY

Background The aim of this study was to investigate whether the introd uction of routine transcranial Doppler (TCD) ultrasonography during ca rotid endarterectomy reduces the incidence of microembolization by alt ering operative technique. Methods The number and nature of microembol i detected during the first 75 consecutive carotid endarterectomies pe rformed with TCD monitoring during 1992-1993 (group I) were compared w ith those in a similar series of 75 consecutive patients undergoing ca rotid endarterectomy in 1995 (group 2), after substantial experience ( 210 patients) with TCD monitoring. Emboli were classified as either pa rticulate or gaseous. Results In patients with evidence of particulate emboli during the dissection phase of the operation, the total number of particulate emboli fell significantly in patients in group 2 (P = 0.019). Similarly, in patients in whom microembolization was detected on immediate opening of the shunt, the total number of microemboli als o fell significantly in group 2 (P = 0.003). Overall, the median (95 p er cent confidence interval) number of particulate emboli detected dur ing the entire procedure fell significantly from 21 (16-29) in group I to 9 (7-14) in group 2 (P = 0.0008). Conclusion TCD monitoring plays an important role in the training and quality control of carotid endar terectomy and helps significantly to reduce the amount of microemboliz ation.