Summary of experience in transcranial Doppler ultrasound monitoring during initial performing carotid endarterectomy

  Objective   To summarize the experience and lessons of transcranial Doppler ultrasonography (TCD) monitoring in primary carotid endarterectomy (CEA).

  Methods   The methods of intraoperative TCD monitoring of CEA for the first time in our hospital were reviewed, the monitoring effect was analyzed, and the experience and lessons were summarized.

  Results   A total of 34 patients underwent TCD monitoring during CEA, with the failure rate of monitoring of 5.9%(2 cases). All the TCD images disappeared after disinfection, and the other 32 cases were able to timely report the intracranial blood flow to the surgeons and anesthesiologists. In 32 patients, after occlusion of the internal carotid artery, the mean flow velocity of the ipsilateral middle cerebral artery decreased by more than 50% occurred in 11 patients (34.4%). After opening the internal carotid artery, the mean flow velocity more than one time of the baseline value occurred in 1 case (3.1%). TCD monitoring during internal carotid artery opening revealed microembolic events occurred in 9 cases (28.1%).

  Conclusion   The key to ensure the smooth progress of TCD monitoring during CEA operation is to make personalized evaluation before operation, properly fix the head frame during operation and make real-time monitoring records, and maintain good communication with surgeons and anesthesiologists.