Application of transcranial Doppler ultrasound in the perioperative period of carotid endarterectomy

Objective To evaluate the application of transcranial Doppler (TCD) in the perioperative period of carotid endarterectomy (CEA). Methods A total of 32 carotid artery stenosis patients underwent CEA from March 2015 to December 2019 in the Affiliated Huai'an Hospital of Xuzhou Medical University. All the patients were evaluated before during and after surgery by TCD. Results There were 17 patients with communicating branches among 23 severe carotid stenosis patients (73.9%). There were 6 patients with communicating branches among 9 moderate carotid stenosis patients (66.7%).The mean velocity (Vm) of middle cerebral artery (MCA) decreased before temporary obstruction compared with those before anesthesia (P<0.05). The MCA Vm decreased after temporary obstruction compared with those before anesthesia and before temporary obstruction (P<0.05). The MCA Vm increased after temporary obstruction was relieved increased compared with those before anesthesia and before temporary obstruction (P<0.05). The invasive blood pressure increased after temporary obstruction compared with those before temporary obstruction (P<0.05). The invasive blood pressure decreased after temporary obstruction was relieved compared with those after temporary obstruction and before temporary obstruction (P<0.05). There were 10 patients with MCA Vm lower than 70% of the basic value,and 3 patients with over 100% increases in MCA Vm after temporary obstruction was relieved compared with those before temporary obstruction. Patients presented increases in MCA Vmax and pulse index (PI) on the diseased side (P<0.05), and the communicating artery was closed. One patient reported headache and three patients presented restlessness. Conclusions TCD can accurately evaluate the openness of intracranial communicating artery before CEA. Real-time monitoring the changes of cerebral hemodynamics during operation, timely regulation of blood pressure, preventing cerebral ischemia and over perfusion in the perioperative period, and evaluating the recovery of cerebral blood flow and the closure of collateral circulation after operation, can promote the success rate of surgery.