Abstract
The purpose of this study was to investigate the correlation between plaque characteristics
and microembolic signals using transcranial Doppler during endarterectomy. We also
investigated successive changes of the pulsality index and average flow velocity in
the ipsilateral middle cerebral artery. The subjects of the study were 28 patients
who underwent carotid endarterectomy. Transcranial Doppler monitoring was performed
before, during, and after carotid endarterectomy. Plaques were classified into 3 types
by the brightness on B-mode ultrasonogram. In addition, extracted specimens were macroscopically
examined to observe the presence of plaque ulcerations and intraplaque hemorrhages.
The blood flow of the internal carotid artery in all cases was measured intraoperatively
using an electromagnetic flow meter. The patients who had plaque ulcerations showed
significantly more microembolic signals preoperatively than those who had intraplaque
hemorrhage during an endarterectomy. Flow velocity in the ipsilateral middle cerebral
artery increased immediately after the operation and reached its peak on the day after
the operation. The pulsality index reached its peak on the day of the operation, and
remained at this point until 2 days after the operation. We conclude that (1) the
patients who had intraplaque hemorrhage had a high risk for embolization of manipulation
during dissection and carotid endarterectomy, and (2) systemic management, including
that of blood pressure under transcranial Doppler monitoring, was necessary for at
least 3 postoperative days in order to prevent hyperperfusion. Copyright © 2003 by
National Stroke Association
Keywords
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Article info
Publication history
Accepted:
August 19,
2002
Received:
May 30,
2002
Footnotes
*Address reprint requests to Kazuhisa Hiramatsu, MD, 1-5-1 Hirotagaya, Kure City, Hiroshima, 737-0193 Japan. E-mail: [email protected]
**1052-3057/03/1202-0001$30.00/0
Identification
Copyright
© 2003 National Stroke Association. Published by Elsevier Inc. All rights reserved.
