Prediction of Cerebral Hyperperfusion after Carotid Endarterectomy with Transcranial Doppler

Objectives: To 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). Design: Patients who underwent carotid endarterectomy between January 2004 and August 2010 and in whom both intra-and postoperative TCD monitoring were performed were included. Methods: In 184 CEA patients the mean velocity (V-mean) preoperatively (V-1), pre-clamping (V-2), post-declamping (V-3) and postoperatively (V-4) was measured using TCD. The intra-operative V-mean increase ((V-3 - V-2)(V-2) was compared to the postoperative increase ((V-4 - V-1)/V-1) in relation to CHS. CHS was diagnosed if the patient developed neurological complaints in the presence of a preoperative V-mean increase >100%. Results: Sixteen patients (9%) had an intra-operative V-mean 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 V-mean increase of >100% and nine postoperative V-mean increase >100%. This results in a positive predictive value of 13% for the intra-operative and 41% for the postoperative measurement. Conclusions: Besides the commonly used intra-operative TCD monitoring additional TCD measurement in the early postoperative phase is useful to more accurately predict CHS after CEA. (C) 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.