The Haemodynamic Effect of Carotid Endarterectomy

Objectives: to assess the haemodynamic effect of carotid artery surgery, and to relate postoperative changes to the state of cerebral circulation before revascularisation. Materials and methods: using transcranial Doppler we studied bilateral middle cerebral artery (MCA) flow velocities before and o...

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Veröffentlicht in:European journal of vascular and endovascular surgery 2002-07, Vol.24 (1), p.53-58
Hauptverfasser: Nielsen, M.-Y., Sillesen, H.H., Jørgensen, L.G., Schroeder, T.V.
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container_issue 1
container_start_page 53
container_title European journal of vascular and endovascular surgery
container_volume 24
creator Nielsen, M.-Y.
Sillesen, H.H.
Jørgensen, L.G.
Schroeder, T.V.
description Objectives: to assess the haemodynamic effect of carotid artery surgery, and to relate postoperative changes to the state of cerebral circulation before revascularisation. Materials and methods: using transcranial Doppler we studied bilateral middle cerebral artery (MCA) flow velocities before and on 1st day, 2nd or 3rd day and 4th or 5th day and 3 months after carotid surgery in 61 patients. In addition, ipsilateral MCA flow velocity was monitored continuously during surgery. Data were related to the internal carotid artery (ICA) perfusion pressure (cerebral perfusion pressure index, CPPI), measured directly before ICA clamping. Results: postoperatively, MCA flow velocities increased significantly overall (p
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Materials and methods: using transcranial Doppler we studied bilateral middle cerebral artery (MCA) flow velocities before and on 1st day, 2nd or 3rd day and 4th or 5th day and 3 months after carotid surgery in 61 patients. In addition, ipsilateral MCA flow velocity was monitored continuously during surgery. Data were related to the internal carotid artery (ICA) perfusion pressure (cerebral perfusion pressure index, CPPI), measured directly before ICA clamping. Results: postoperatively, MCA flow velocities increased significantly overall (p&lt;0.01), mainly due to pronounced and longer lasting flow velocities in the group of 18 patients with CPPI&lt;0.7 (p&lt;0.05). Flow velocities peaked – absolute as well as relative – on the first postoperative day and then gradually levelled off to reach preoperative values after 4–5 days in patients with high CPPI, whereas MCA flow velocities remained increased in the group of patients with low CPPI. At 3 months flow velocities in both groups were normalised. New neurological symptoms occurred in four patients, who all had low CPPI preoperatively (22% (4/18) vs 0%; Fisher's exact test: p=0.006). Conclusion: some degree of hyperperfusion was seen in most patients, but the changes were significantly more pronounced in patients with preoperative hypoperfusion, who also suffered significantly more neurological complications.</description><identifier>ISSN: 1078-5884</identifier><identifier>EISSN: 1532-2165</identifier><identifier>DOI: 10.1053/ejvs.2002.1702</identifier><identifier>PMID: 12127848</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Aged ; Aged, 80 and over ; Cerebrovascular Circulation ; Endarterectomy, Carotid - adverse effects ; Female ; Haemodynamics, Carotid endarterectomy, Cerebral blood flow, Transcranial Doppler ; Hemodynamics ; Humans ; Male ; Middle Aged ; Middle Cerebral Artery - diagnostic imaging ; Middle Cerebral Artery - physiopathology ; Treatment Outcome ; Ultrasonography, Doppler, Transcranial</subject><ispartof>European journal of vascular and endovascular surgery, 2002-07, Vol.24 (1), p.53-58</ispartof><rights>2002 Elsevier Science Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c380t-a262c5a6e978b52cf7565a40bbcd6f9f19fef7a8c5e83b090af5e275e5d584ed3</citedby><cites>FETCH-LOGICAL-c380t-a262c5a6e978b52cf7565a40bbcd6f9f19fef7a8c5e83b090af5e275e5d584ed3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1053/ejvs.2002.1702$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12127848$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nielsen, M.-Y.</creatorcontrib><creatorcontrib>Sillesen, H.H.</creatorcontrib><creatorcontrib>Jørgensen, L.G.</creatorcontrib><creatorcontrib>Schroeder, T.V.</creatorcontrib><title>The Haemodynamic Effect of Carotid Endarterectomy</title><title>European journal of vascular and endovascular surgery</title><addtitle>Eur J Vasc Endovasc Surg</addtitle><description>Objectives: to assess the haemodynamic effect of carotid artery surgery, and to relate postoperative changes to the state of cerebral circulation before revascularisation. 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At 3 months flow velocities in both groups were normalised. New neurological symptoms occurred in four patients, who all had low CPPI preoperatively (22% (4/18) vs 0%; Fisher's exact test: p=0.006). 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Materials and methods: using transcranial Doppler we studied bilateral middle cerebral artery (MCA) flow velocities before and on 1st day, 2nd or 3rd day and 4th or 5th day and 3 months after carotid surgery in 61 patients. In addition, ipsilateral MCA flow velocity was monitored continuously during surgery. Data were related to the internal carotid artery (ICA) perfusion pressure (cerebral perfusion pressure index, CPPI), measured directly before ICA clamping. Results: postoperatively, MCA flow velocities increased significantly overall (p&lt;0.01), mainly due to pronounced and longer lasting flow velocities in the group of 18 patients with CPPI&lt;0.7 (p&lt;0.05). Flow velocities peaked – absolute as well as relative – on the first postoperative day and then gradually levelled off to reach preoperative values after 4–5 days in patients with high CPPI, whereas MCA flow velocities remained increased in the group of patients with low CPPI. 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subjects Aged
Aged, 80 and over
Cerebrovascular Circulation
Endarterectomy, Carotid - adverse effects
Female
Haemodynamics, Carotid endarterectomy, Cerebral blood flow, Transcranial Doppler
Hemodynamics
Humans
Male
Middle Aged
Middle Cerebral Artery - diagnostic imaging
Middle Cerebral Artery - physiopathology
Treatment Outcome
Ultrasonography, Doppler, Transcranial
title The Haemodynamic Effect of Carotid Endarterectomy
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