Article

Use of transcranial Doppler sonography and acetazolamide test to demonstrate changes in cerebrovascular reserve capacity following carotid endarterectomy.

Department of Neurosurgery, Albert Szent-Györgyi Medical University, Szeged, Hungary.
European Journal of Vascular and Endovascular Surgery (impact factor: 2.99). 01/1996; 11(1):83-9. pp.83-9
Source: PubMed

ABSTRACT To assess the effect of carotid endarterectomy on cerebrovascular reserve capacity.
Cerebral blood flow velocity (CBFV) and cerebrovascular reserve capacity (CVRC) were measured by transcranial Doppler sonography (TCD) and acetazolamide test in 40 patients who underwent uncomplicated unilateral carotid endarterectomy (CEA). Indication for operation was limited to stenoses > 70% as documented by angiography and/or Duplex scanning. The TCD studies were carried out 6 days (range 1-14 days) before and 8 days (range 5-12 days) after endarterectomy.
Before endarterectomy, resting CBFV values and CVRC in the 40 patients were significantly different between the operated (51 +/- 19 cm/s; 20 +/- 16%) and the non-operated (60 +/- 19 cm/s; 34 +/- 24%) hemisphere (p < 0.05;p < 0.01). After CEA the overall increase of resting CBFV of the operated side was highly significant with preoperative CBFV values of 51 +/- 19cm/s and postoperative values of 62 +/- 15 cm/s (p < 0.01). Cerebrovascular reserve capacity after operation was increased on both sides significantly (non-operated side: from 34 +/- 24% to 43 +/- 19%, p < 0.05; operated side: from 20 +/- 16% to 51 +/- 18%, p < 0.001), and the preoperative asymmetry was no longer present.
CEA has a beneficial effect on the cerebral circulation in most patients, even those who presented with asymptomatic carotid artery stenosis. Since CVRC has been assessed in the early postoperative period, our findings also suggest that cerebral vascular adaption occurs within 2 weeks after CEA.

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    Article: Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.
    M A Sloan, A V Alexandrov, C H Tegeler, M P Spencer, L R Caplan, E Feldmann, L R Wechsler, D W Newell, C R Gomez, V L Babikian, D Lefkowitz, R S Goldman, C Armon, C Y Hsu, D S Goodin
    [show abstract] [hide abstract]
    ABSTRACT: To review the use of transcranial Doppler ultrasonography (TCD) and transcranial color-coded sonography (TCCS) for diagnosis. The authors searched the literature for evidence of 1) if TCD provides useful information in specific clinical settings; 2) if using this information improves clinical decision making, as reflected by improved patient outcomes; and 3) if TCD is preferable to other diagnostic tests in these clinical situations. TCD is of established value in the screening of children aged 2 to 16 years with sickle cell disease for stroke risk (Type A, Class I) and the detection and monitoring of angiographic vasospasm after spontaneous subarachnoid hemorrhage (Type A, Class I to II). TCD and TCCS provide important information and may have value for detection of intracranial steno-occlusive disease (Type B, Class II to III), vasomotor reactivity testing (Type B, Class II to III), detection of cerebral circulatory arrest/brain death (Type A, Class II), monitoring carotid endarterectomy (Type B, Class II to III), monitoring cerebral thrombolysis (Type B, Class II to III), and monitoring coronary artery bypass graft operations (Type B to C, Class II to III). Contrast-enhanced TCD/TCCS can also provide useful information in right-to-left cardiac/extracardiac shunts (Type A, Class II), intracranial occlusive disease (Type B, Class II to IV), and hemorrhagic cerebrovascular disease (Type B, Class II to IV), although other techniques may be preferable in these settings.
    Neurology 06/2004; 62(9):1468-81. · 8.31 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

2 weeks
 
40 patients
 
6 days
 
8 days
 
asymptomatic carotid artery stenosis
 
carotid endarterectomy
 
Cerebral blood flow velocity
 
cerebral circulation
 
cerebral vascular adaption
 
cerebrovascular reserve capacity
 
non-operated
 
non-operated side
 
postoperative values
 
preoperative CBFV values
 
range 1-14 days
 
range 5-12 days
 
resting CBFV values
 
TCD studies
 
transcranial Doppler sonography
 
uncomplicated unilateral carotid endarterectomy