Comprehensive evaluation of brain and carotid ultrasound in perioperative period of carotid endarterectomy

ObjectiveTo analyze the comprehensive evaluation of brain and carotid ultrasound in perioperative period of carotid endarterectomy(CEA).

MethodsThe transcranial Doppler(TCD) and carotid ultrasound in 60 patients treated with CEA were examined during the perioperative period.The results of preoperative, intraoperative and postoperative examination were recorded.Using preoperative digital subtraction angiography(DSA) as the golden standard, the accuracy of carotid artery stenosis detected by carotid ultrasound was analyzed.The detection rate of collateral circulation opening was compared between DSA and TCD, and the perioperative indicators were compared between carotid ultrasound and TCD.

ResultsThe sensitivity, specificity, accuracy and Kappa value of carotid ultrasound in the detection of 50% to 69% stenosis were 66.67%(6/9), 100.00%(51/51), 95.00%(57/60) and 0.77, respectively.The detections rates of TCD for anterior communicating artery opening, posterior communicating artery opening and internal-external carotid artery opening were 91.07%, 85.96% and 87.50%, respectively.The preoperative carotid ultrasound showed that the diameter of the stenosis narrowed, and the blood flow velocity was higher than that of normal people.Carotid ultrasound found that the vascular stenosis on the operative side was effectively relieved after the stenosis was removed by operation.The intima of upper and lower margins was well fixed, there was no intimal floating in lumen, and the blood flowing was smooth.The PSV, EDV and PSVICA/PSVCCA at carotid artery opening and after 1 week of operation were significantly lower than those before surgery(P < 0.01), and the internal diameter of stenosis was significantly larger than that before surgery(P < 0.01).TCD examination showed that the PSV, EDV, MV and PI at carotid artery opening and after 1 week of operation were significantly higher than those after 5 to 10 minutes of anesthesia(P < 0.01), and all indictors returned to the normal level.The blood flow velocity of middle cerebral artery in 2 cases were more than 200% above the basal level.To avoid excessive perfusion, the proximal common carotid artery was clamped again, the blood pressure value decreased for 10 to 30 minutes, and the flow rate was restored in the end.

ConclusionsTCD combined with carotid artery ultrasound can provide the accurate and effective objective basis for preoperative examination, intraoperative monitoring and postoperative evaluation of CEA, which has great application value in successful operation of patients.