Transcranial Doppler in the management of extracranial cerebrovascular disease: Implications in diagnosis and monitoring

Schneider, Peter A.; Rossman, M E; Torem, Shlomo; Otis, Shirley M.; Dilley, Ralph B.; Bernstein, Eugene F.

doi:10.1016/0741-5214(88)90140-1

Cited by 66 publications

(25 citation statements)

References 13 publications

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“…1516 More recently, initial evaluations of the use of TCD in continuous intraoperative cerebral monitoring have been promising. 4 -6 We have previously shown a direct correlation between SP and mean MCAV during cross clamping, 11 which has also been observed by others. 12 TCD has the advantage of providing continuous information on the current circulatory status of the brain, whereas SP provides only a single, initial measurement.…”

Section: Discussionsupporting

confidence: 48%

Importance of cerebral collateral pathways during carotid endarterectomy.

Schneider

Ringelstein

Rossman

et al. 1988

Stroke

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Before surgery, we evaluated major intracranial collateral pathways using transcranial Doppler ultrasonography (TCD) in 50 patients who then underwent carotid endarterectomy with concurrent multimodality cerebral monitoring. Patients were grouped with respect to collateral pathways demonstrated preoperatively by TCD: Group 1, good collateralization with an anterior and/or a posterior communicating artery ipsilateral to the operative carotid lesion (29 patients, 58%); Group 2, collateral pathways present but impeded by other proximal stenoses (nine patients, 18%); and Group 3, no collateralization identified (nine patients, 18%). Three patients (6%) could not be classified. TCD identified major collateral pathways with a sensitivity of 89% and a specificity of 80% when compared with arteriography. During carotid endarterectomy mean middle cerebral artery velocity, pulsatility index, and stump pressure were higher and the decrease in middle cerebral artery velocity with extracranial carotid artery cross clamping was significantly less among Group 1 patients than among Group 2 and 3 patients (p<0.Q5 for both groups). Group 1 patients required fewer intraoperative carotid artery shunts and developed fewer ischemic electroencephalographic abnormalities than did patients in Groups 2 and 3 (p<0.05 for both groups). TCD assessment of cerebral collateralization helps predict hemodynamic consequences of cross clamping during carotid endarterectomy. (Stroke 1988;19:1328-1334) C erebrovascular collateral blood supply plays an essential role in cerebral perfusion. In patients undergoing carotid endarterectomy the correlation of preoperative assessment of collateral potential with cerebral perfusion during extracranial carotid artery cross clamping enhances our understanding of intracerebral hemodynamics.Transcranial Doppler ultrasonography (TCD) can directly insonate the intracranial arteries to evaluate collateral perfusion around the circle of Willis. '-3 In addition, TCD provides continuous noninvasive monitoring of middle cerebral artery (MCA) blood velocity (MCAV) and immediately detects changes in cerebral perfusion during carotid artery manipulation and cross clamping.4 -6 The purposes of our study were to correlate prospectively the

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Section: Discussionsupporting

confidence: 48%

Importance of cerebral collateral pathways during carotid endarterectomy.

Schneider

Ringelstein

Rossman

et al. 1988

Stroke

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“…In contrast to other authors [14,16], we found no significant reduction of the ipsilateral MCA flow velocity in most cases of ICA obstruction. In patients with unilateral ICA stenosis, systolic peak and time-mean velocity in the postobstructive MCA did not vary greatly from values found on the normal side.…”

Section: Discussioncontrasting

confidence: 85%

Transcranial Doppler ultrasound in internal carotid artery and middle cerebral artery disease

et al. 1992

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Using noninvasive transcranial Doppler sonography, we studied cerebral collateral patterns in 30 patients with stenosis and/or occlusion of the extracranial internal carotid artery (ICA). All patients with unilateral ICA stenosis less than or equal to 80% had normal transcranial Doppler findings. 80% of patients with unilateral and 50% of patients with bilateral ICA stenosis of more than 80% including those with occlusion showed a collateralization via the ipsilateral anterior and/or posterior cerebral artery. 20% of patients with unilateral and 50% of patients with bilateral ICA stenoses of more than 80% (including occlusion) had two or three collateral pathways, including the ophthalmic artery. Another ten patients with stenosis or spasm of the middle cerebral artery (MCA) showed increased flow velocities with turbulence in the narrow segment. In four patients with severe MCA disease with a systolic peak velocity of more than 200 cm/s, the Doppler waveform distal to the lesion was damped. Decreased regional cerebral blood flow (rCBF) measured by 99mTc-HMPAO-SPECT was found in two patients with severe MCA stenosis. Another patient with moderate MCA stenosis with a systolic peak velocity of 140 cm/s showed a normal cerebral perfusion pattern.

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“…In particular, changes to compensatory collateral blood flow via peri- orbital vessels and the ACoA were docum ented at the first post-operative examination, and probably occurred im mediately post-operatively. In the m ajority of cases (65%), CEA produced an increase in steady-state ipsilat eral MCA velocity, confirming results from other studies [15]. Why ipsilateral MCA velocity was reduced in some patients is uncertain.…”

Section: Discussionsupporting

confidence: 77%

Hyperperfusion Post-Endarterectomy

Chambers¹,

Smidt²,

Koh³

1993

Cerebrovasc Dis

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We performed serial transcranial Doppler examinations on 35 patients undergoing 40 consecutive carotid endarterectomies (CEAs) to study alterations in collateral flow and middle cerebral artery (MCA) blood flow velocity. Ipsilateral peri-orbital collateral flow was abolished abruptly in all 16 cases. Compensatory anterior communicating artery collateral was abolished in 17 of 18 cases, and reversed in the other with a remaining severe contralateral carotid lesion. Post-operatively, ipsilateral MCA velocity increased significantly in 26 cases, decreased in 7, and remained unchanged in 7. Sixteen patients had transient hyperperfusion during the first week. Similar changes were observed on the contralateral side. There was no significant association between hyperperfusion and clinical or physiological variables except age. One patient had ipsilateral headache post-operatively associated with hyperperfusion. We conclude that CEA produces rapid alterations of collateral flow and may affect blood flow to both cerebral hemispheres. Transient hyperperfusion, although common, is seldom severe and rarely symptomatic.

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Transcranial Doppler in the management of extracranial cerebrovascular disease: Implications in diagnosis and monitoring

Cited by 66 publications

References 13 publications

Importance of cerebral collateral pathways during carotid endarterectomy.

Importance of cerebral collateral pathways during carotid endarterectomy.

Transcranial Doppler ultrasound in internal carotid artery and middle cerebral artery disease

Hyperperfusion Post-Endarterectomy

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