[Collateral supply in patients with severe carotid stenosis]

Area of Science:

• Neurology
• Vascular Surgery
• Medical Imaging

Context:

• Carotid stenosis poses a risk of ischemic stroke.
• Adequate collateral circulation is crucial during carotid endarterectomy (CEA).
• Assessing collateral pathways (anterior/posterior communicating arteries, ophthalmic artery) is vital.

Purpose:

• To evaluate the sufficiency of collateral blood supply in patients with carotid stenosis.
• To determine the utility of Transcranial Doppler (TCD) and stump pressure (SP) in assessing collateral function.
• To correlate preoperative and intraoperative assessments of collateral circulation.

Summary:

• Fifteen patients with carotid stenosis underwent CEA.
• Preoperative TCD assessed collateral pathways; intraoperative TCD monitored ipsilateral middle cerebral artery mean velocity (mvMCA) and stump pressure (SP).
• TCD and SP showed agreement in assessing collateral adequacy in 9 cases and were common in 12 patients.

Impact:

• Transcranial Doppler (TCD) is a valuable tool for assessing collateral circulation sufficiency in severe carotid stenosis.
• Monitoring ipsilateral mvMCA changes during CEA using TCD is particularly useful.
• This evaluation aids in preventing cerebral ischemia during carotid revascularization procedures.