This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Doblar, D. D. Articles by McDowell, H. Search for Related Content PubMed PubMed Citation Articles by Doblar, D. D. Articles by McDowell, H.

(Stroke. 1998;29:2038-2042.)
© 1998 American Heart Association, Inc.

Original Contributions

Predicting the Effect of Carotid Artery Occlusion During Carotid Endarterectomy

Comparing Transcranial Doppler Measurements and Cerebral Angiography

Dennis D. Doblar, PhD, MD; Nataliya V. Plyushcheva, PhD, MD; William Jordan, MD; Holt McDowell, MD

From the Departments of Anesthesiology (D.D.D., N.V.P.), Biomedical Engineering (D.D.D.), and Surgery (W.J., H.M.), University of Alabama at Birmingham.

Correspondence to Dennis D. Doblar, PhD, MD, Department of Anesthesiology, Room JT 949, University of Alabama, 619 S 19th St, Birmingham, AL 35233. E-mail ddoblar{at}ms.jt.anes.uab.edu

Background and Purpose—We correlated the mean transcranial Doppler blood flow velocity (FVm) during carotid endarterectomy with the functional collateral pathway(s) documented by angiography.

Methods—Three patient groups were established: group 1 was dependent on the anterior communicating artery, group 2 on the anterior communicating artery and ipsilateral posterior communicating artery, and group 3 on the ipsilateral posterior communicating artery. Continuous middle cerebral artery FVm and electroencephalographic monitoring were performed in 45 patients during carotid endarterectomy.

Results—Clamped FVm was lowest in group 3 at 17±9 cm/s versus 36±16 and 33±11 cm/s for groups 1 and 2 (P<0.01). FVm values in groups 1 and 2 were similar. There was significant cerebral arterial vasodilation in group 3 patients on the basis of a pulsatility index of 0.38±0.15. The maximum FVm after clamp release was similar among the 3 groups. Normalized blood flow velocity 1 minute before release of the clamp was increased from the minimum flow velocity after clamping only in group 1 and 2 patients.

Conclusions—The ipsilateral posterior communicating artery is a minor collateral pathway during acute carotid occlusion that contributes little to the collateral flow if there is a functional anterior communicating artery. Collateral flow through the middle cerebral artery is not recruited during occlusion in group 3 patients. The reperfusion FVm transient is independent of the primary collateral pathway. Documentation of functional collateral pathways on the basis of Doppler or angiographic examination may be advantageous in future studies since it can provide the basis for comparison among studies.

Key Words: carotid artery occlusion • carotid endarterectomy • collateral circulation • ultrasonography, Doppler, transcranial

This article has been cited by other articles:

				D. D. Doblar Intraoperative Transcranial Ultrasonic Monitoring for Cardiac and Vascular Surgery Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2004; 8(2): 127 - 145. [Abstract] [PDF]

				D. W. Droste, R. Jurgens, S. Weber, R. Tietje, and E. B. Ringelstein Benefit of Echocontrast-Enhanced Transcranial Color-Coded Duplex Ultrasound in the Assessment of Intracranial Collateral Pathways Stroke, April 1, 2000; 31(4): 920 - 923. [Abstract] [Full Text] [PDF]

				R. T.F. Cheung, D. D. Doblar, N. V. Plyushcheva, W. Jordan, and H. McDowell Transcranial Doppler Monitoring of Carotid Artery Occlusion During Endarterectomy • Response Stroke, June 1, 1999; 30(6): 1288 - 1288. [Full Text] [PDF]