Document Detail

Transcranial Doppler ultrasonography-guided management of internal carotid artery closure.
MedLine Citation:
PMID:  10414569     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To emphasize the integrated use of transcranial Doppler ultrasonography (TCD) in the management of internal carotid artery (ICA) closure. METHODS: Thirty-three patients being considered for ICA closure underwent TCD assessment, vasomotor reserve testing/estimation, and carotid artery test occlusion with concomitant middle cerebral artery (MCA) blood velocity (V(MCA)) monitoring, including calculation of the MCA pulsatility index. Twelve of these patients proceeded to undergo ICA sacrifice. Sequential TCD sonograms guided their postoperative treatment. RESULTS: ICA aneurysms and neck neoplasms affected the TCD results and vasomotor reserve insignificantly, whereas carotid-cavernous fistulae induced characteristic circulatory alterations. The 10 subjects who tolerated ICA sacrifice hemodynamically all showed an initial decrease in the ipsilateral V(MCA) to > or =60% of the preocclusion value and a progressively decreasing MCA pulsatility index during carotid artery test occlusion. The two patients who developed hemodynamic cerebral infarctions exhibited a decrease in V(MCA) to <60% and a MCA pulsatility index that remained stable after a vast initial reduction. Postoperative hypervolemic and hypertensive support was safely titrated in all patients who received postoperative TCD surveillance, providing an ipsilateral V(MCA) of > or =80% of the preocclusion value. ICA closure permanently altered the cerebral circulatory pattern. CONCLUSION: The hemodynamic outcome of ICA sacrifice can be correctly predicted by using the TCD occlusion test. TCD provides the means to titrate the extent of postoperative hypervolemic/hypertensive support.
W Sorteberg; A Sorteberg; K F Lindegaard; M Boysen; H Nornes
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  45     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  1999 Jul 
Date Detail:
Created Date:  1999-09-14     Completed Date:  1999-09-14     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  76-87; discussion 87-8     Citation Subset:  IM    
Department of Neurosurgery, Rikshospitalet, The National Hospital, University of Oslo, Norway.
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MeSH Terms
Aneurysm / complications,  surgery,  ultrasonography
Arteriovenous Fistula / complications,  surgery,  ultrasonography
Blood Flow Velocity / physiology
Brain / blood supply
Carotid Artery, Internal / surgery*,  ultrasonography
Carotid Sinus / surgery,  ultrasonography
Carotid Stenosis / etiology,  surgery*,  ultrasonography
Head and Neck Neoplasms / complications,  surgery,  ultrasonography
Middle Aged
Postoperative Complications / ultrasonography
Pulsatile Flow / physiology
Ultrasonography, Doppler, Transcranial / instrumentation*

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