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A Journal on Angiology

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 1999 December;18(4):271-6

language: English

Evaluation of blood flow veloc­ity chang­es in mid­dle cere­bral ­artery from con­tra­lat­er­al trans­or­bi­tal ­approach as the alter­na­tive meth­od of mon­i­tor­ing dur­ing carot­id sur­gery in ­patients with no tem­po­ral acous­tic “win­dow”

Staszkiewicz W., Antepowicz W., Madycki G., Dabek P., Gabrusiewicz A.

From the Department of Vascular Surgery C.M.K.P., Warsaw, Poland


Background. We eval­u­at­ed the pos­sibil­ity of util­is­ing the trans­or­bi­tal ­approach for mid­dle cere­bral ­artery (MCA) blood flow veloc­ity mon­i­tor­ing as the alter­na­tive meth­od of intra­op­er­a­tive eval­u­a­tion of cere­bral ischae­mia risk in ­patients with no tem­po­ral acous­tic “win­dow”.
Methods. We inso­nat­ed the MCA from con­tra­lat­er­al, trans­or­bi­tal ­approach at a depth rang­ing from 68 to 80 mm. Ten ­patients with no tem­po­ral win­dow (group A) under­go­ing carot­id sur­gery were exam­ined intra­op­er­a­tive­ly by means of this meth­od.
Results. For com­par­i­son a ref­er­ence group of 15 ­patients with tem­po­ral acous­tic win­dows ­present (group B) was estab­lished. In this group, the simul­ta­ne­ous (dou­ble) ­records of MCA blood flow veloc­ity chang­es from trans­tem­po­ral and trans­or­bi­tal approach­es dur­ing carot­id endar­te­rec­to­my (CEA) were con­duct­ed. Mean blood flow veloc­ity (Vmean) was record­ed after anaesthe­sia, dur­ing a 120-sec clamp test, after shunt inser­tion (if nec­es­sary), imme­di­ate­ly after and 5 min after clamp ­release.
Conclusions. We would rec­om­mend trans­or­bi­tal Doppler mon­i­tor­ing as a meth­od of ­choice when the trans­tem­po­ral ­approach is not pos­sible. Although quite dif­fi­cult, this meth­od ­appears to be safe and reli­able in the intra­op­er­a­tive eval­u­a­tion of ­patients at risk of cere­bral ischae­mia.

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