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International Angiology 1999 December;18(4):271-6

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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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