Investigation on cerebral hemodynamics in patients with carotid disease receiving carotid endarterectomy

100 patients (pts) receiving CEA (carotid endarterectomy) were evaluated in this study. In some of them postoperative complications were observed, cha racterized by TIA (transient ischemic attack) and, mostly, by cerebral hype rperfusion. In only two of the pts investigated CEA needed the implantation of a shunt, due to the emergence of intolerance signs at carotid Clamping (C) evaluated by TCD (transcranial Doppler); the preoperative cerebral angi ography in the two subjects in question did not show malformations of the c ircle of Willis. The hyperperfusive phenomenon and the absence of intracran ial compensation hows during CEA seemed to be ascribed to a more or less se vere impairment of cerebral reserve. Such impairment of the autoregulatory capacity seems to be crucial to the pathogenesis of hemodynamic stroke. Thu s the indication to CEA, in pts with severe carotid disease, should take in to account also the cerebral reserve (CR) impairment to prevent both thromb oembolic and hemodynamic stroke. The predictive and diagnostic role of TCD turns out to be crucial in assessing and selecting pts candidate to CEA.