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Cross-flow determination by transcranial Doppler predicts clamping ischemia in patients undergoing carotid endarterectomy

AIM: Aim of the paper was to assess the reliability of preoperative cross-flow determination by transcranial Doppler measurement (TCD) to detect clamping ischemia in patients undergoing carotid endarterectomy with selective shunting. - METHODS: Retrospective one-to-one matched-pair analysis of 72 pa...

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Main Authors: Attigah, Nicolas (Author) , Demirel, Serdar (Author) , Ringleb, Peter A. (Author) , Hinz, Ulf (Author) , Hyhlik-Dürr, Alexander (Author) , Böckler, Dittmar (Author)
Format: Article (Journal)
Language:English
Published: 2015
In: The journal of cardiovascular surgery
Year: 2013, Volume: 56, Issue: 3, Pages: 417-422
ISSN:1827-191X
Online Access:Verlag, lizenzpflichtig, Volltext: https://pubmed.ncbi.nlm.nih.gov/23867860/
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Author Notes:N. Attigah, S. Demirel, P. Ringleb, U. Hinz, A. Hyhlik-Dürr, D. Böckler

MARC

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520 |a AIM: Aim of the paper was to assess the reliability of preoperative cross-flow determination by transcranial Doppler measurement (TCD) to detect clamping ischemia in patients undergoing carotid endarterectomy with selective shunting. - METHODS: Retrospective one-to-one matched-pair analysis of 72 patients undergoing carotid endarterectomy with preoperative TCD scanning. Matching criteria were gender, degree of contralateral stenosis and the type of stenosis (asymptomatic or symptomatic). - RESULTS: Patients in need for a secondary shunt insertion had significantly less cross-flow in preoperative TCD measurement (N.=14; 38.89%) compared to the control group (N.=32; 88.89%: P=0.0001%). The sensitivity of the cross-flow determination to predict clamping ischemia was 88.9%, the specificity 61.1%. The risk of developing a clamping ischemia in the absence of a cross-flow was 12 fold higher (OR: 12.6; 95% CI: 3.7-43.3). The existence of circulatory impairment of the MCA was associated with the presence of a collateral flow in the ACoA (OR 3.21; P=0.0531; likelihood ratio test 0.0481). Other factors like renal insufficiency, the degree of stenosis or the stump pressure showed no association with a cross-flow of the ACoA in a multivariate model. - CONCLUSION: TCD scanning is highly reliable to detect cross-flow prior to carotid surgery and thus helpful to identify patients at risk for clamping ischemia and need for shunting. 
534 |c 2013 
650 4 |a Aged 
650 4 |a Asymptomatic Diseases 
650 4 |a Brain Ischemia 
650 4 |a Carotid Stenosis 
650 4 |a Cerebrovascular Circulation 
650 4 |a Collateral Circulation 
650 4 |a Constriction 
650 4 |a Endarterectomy, Carotid 
650 4 |a Feasibility Studies 
650 4 |a Female 
650 4 |a Humans 
650 4 |a Logistic Models 
650 4 |a Male 
650 4 |a Matched-Pair Analysis 
650 4 |a Middle Aged 
650 4 |a Odds Ratio 
650 4 |a Predictive Value of Tests 
650 4 |a Reproducibility of Results 
650 4 |a Retrospective Studies 
650 4 |a Risk Assessment 
650 4 |a Risk Factors 
650 4 |a Severity of Illness Index 
650 4 |a Ultrasonography, Doppler, Duplex 
650 4 |a Ultrasonography, Doppler, Transcranial 
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