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The Journal of Cardiovascular Surgery 2021 Apr 08

DOI: 10.23736/S0021-9509.21.11705-7


language: English

Age corrected changes in intracranial haemodynamics after carotid endarterectomy

Mirte SCHAAFSMA 1 , Gerard J. GLADE 2, B. Paul KELLER 2, Arjen SCHAAFSMA 2

1 Amsterdam University Medical Centre, Amsterdam, the Netherlands; 2 Department of Vascular Surgery, Department of Clinical Neurophysiology, Martini Ziekenhuis Groningen, Groningen, the Netherlands


BACKGROUND: Transcranial Doppler ultrasound (TCD) is a frequently used method to monitor brain perfusion during and following carotid endarterectomy (CEA). Our aim was to define the normally occurring changes of intracranial haemodynamics in patients undergoing CEA measuring recently developed TCD parameters.
METHODS: A retrospective, single-centre cohort study was performed. Patients undergoing CEA were evaluated pre- and postoperatively from day 0 to day 3 measuring middle cerebral artery flow velocity (MCAFV). The following parameters were analysed: the first systolic peak (Sys1), the second systolic peak (Sys2) and diastolic flow velocity at a fixed time after heartbeat onset (Dias@560). These parameters decrease linearly with age and were, therefore, transformed to Z-scores.
RESULTS: 318 patients were included with a mean age of 70.8 years. The majority of patients was male (71%). Compared to preoperatively, the Z-scores of Sys1 and Sys2 were larger on postoperative day 3: +1.12 standard deviation (SD) or 16.0 cm/s (CI: 0.93 to 1.32; p<.001) and +0.55 SD or 7.8 cm/s (CI: 0.35 to 0.74; p<.001), respectively. The Z-score for Dias@560 was smaller than preoperatively: -0.23 SD or -1.9 cm/s (CI: -0.41 to -0.05, p=.015).
CONCLUSIONS: Under normal circumstances Sys1 profits more from CEA than Sys2, whilst diastolic flow velocity decreases. This indicates a return to normal arteriolar vascular resistance. Carefully describing normal changes in MCAFV, may in future enable discrimination of abnormalities, such as hyperperfusion syndrome.

KEY WORDS: Carotid endarterectomy; Carotid stenosis; Transcranial Doppler ultrasonography; Intra-cranial haemodynamics

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