When to perform transcranial Doppler to predict cerebral hyperperfusion after carotid endarterectomy?

Claire W. Pennekamp , Selma C. Tromp , Rob G. Ackerstaff , Michiel L. Bots , Rogier V. Immink , Wilco Spiering , Jean-Paul P. de Vries , Jaap Kappelle , Frans L. Moll , Wolfgang F. Buhre , Gert J. de Borst
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Abstract

Cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy (CEA) is a potential life-threatening disease. Identification of patients at risk for CHS commonly takes place with use of intra-operative transcranial Doppler (TCD), but is associated with both false positive and false negative results. We aimed to determine the diagnostic value for predicting CHS, by adding a TCD measurement in the early post-operative phase after CEA.

We retrospectively included 72 patients who underwent CEA between January 2004 and August 2010 and in whom both intra- and post-operative TCD of the ipsilateral middle cerebral artery monitoring were performed. Twelve patients (17%) had an intra-operative mean blood flow velocity (Vmean) increase >100% and 13 patients (18%) a post-operative Vmean increase of >100%. In 5 patients (7%) CHS was diagnosed; 2 of those had an intra-operative Vmean increase of >100% and all 5 a post-operative Vmean increase >100%. This results in a positive predictive value of 17% for the intra-operative and 38% for the post-operative measurement.

In conclusion, a post-operative increase of the mean velocity in the ipsilateral middle cerebral artery of >100% as measured by TCD is superior to an intra-operative velocity increase, for the identification of patients at risk for the development of CHS after CEA.

经颅多普勒预测颈动脉内膜切除术后脑过度灌注的时机
颈动脉内膜切除术后脑过度灌注综合征(CHS)是一种潜在的危及生命的疾病。通常使用术中经颅多普勒(TCD)来识别有CHS风险的患者,但与假阳性和假阴性结果相关。我们的目的是通过在CEA术后早期增加TCD测量来确定预测CHS的诊断价值。我们回顾性地纳入了2004年1月至2010年8月期间接受CEA的72例患者,这些患者在术中和术后均进行了同侧大脑中动脉TCD监测。12例(17%)患者术中平均血流速度(Vmean)增加了100%,13例(18%)患者术后Vmean增加了100%。5例(7%)患者被诊断为CHS;其中2例术中Vmean升高100%,5例术后Vmean升高100%。这使得术中测量的阳性预测值为17%,术后测量的阳性预测值为38%。综上所述,术后TCD测量的同侧大脑中动脉平均流速增加100%优于术中流速增加,用于CEA后发生CHS的高危患者的识别。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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