Prediction of Cerebral Hyperperfusion after Carotid Endarterectomy with Transcranial Doppler

ObjectivesTo determine the diagnostic value for predicting cerebral hyperperfusion syndrome (CHS) by adding a transcranial Doppler (TCD) measurement in the early postoperative phase after carotid endarterectomy (CEA).DesignPatients who underwent carotid endarterectomy between January 2004 and August 2010 and in whom both intra- and postoperative TCD monitoring were performed were included.MethodsIn 184 CEA patients the mean velocity (Vmean) preoperatively (V1), pre-clamping (V2), post-declamping (V3) and postoperatively (V4) was measured using TCD. The intra-operative Vmean increase ((V3 − V2)/V2) was compared to the postoperative increase ((V4 − V1)/V1) in relation to CHS. CHS was diagnosed if the patient developed neurological complaints in the presence of a preoperative Vmean increase >100%.ResultsSixteen patients (9%) had an intra-operative Vmean increase >100% and 22 patients (12%) a postoperative Vmean increase of >100%. In 10 patients (5%) CHS was diagnosed; two of those had an intra-operative Vmean increase of >100% and nine postoperative Vmean increase >100%. This results in a positive predictive value of 13% for the intra-operative and 41% for the postoperative measurement.ConclusionsBesides the commonly used intra-operative TCD monitoring additional TCD measurement in the early postoperative phase is useful to more accurately predict CHS after CEA.