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The value of cerebral blood flow measurement in carotid surgery
1Department Neurology and Clin. Neurophysiology, Munich, FRG.
Insights
Carotid surgery is debated due to risks and costs. New Doppler ultrasound and transcranial methods help identify embolism sources and assess brain blood supply endangerment for better surgical decisions.
Area of Science:
- Neurology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Carotid surgery carries significant risks and costs, prompting reevaluation of its necessity.
- Indications for carotid surgery include confirmed embolism sources or certain brain blood supply endangerment.
Purpose of the Study:
- To discuss the expediency of carotid surgery in light of diagnostic advancements.
- To review diagnostic procedures for assessing brain blood supply endangerment and embolism sources.
Main Methods:
- High-resolution Doppler ultrasound for embolism source detection.
- Transcranial techniques for embolism source detection.
- Measurement of regional cerebral blood flow.
- Assessment of collateral circulations.
- Determination of cerebral blood system reserve capacity.
Main Results:
- Reliable detection of embolism sources is now possible with advanced imaging.
- Assessing brain blood supply endangerment requires comprehensive hemodynamic evaluation.
- Current diagnostic procedures and their clinical relevance are discussed.
Conclusions:
- Carotid surgery indications are refined by new diagnostic capabilities.
- Further development of functional criteria is needed for reliable assessment of cerebral blood system status.
- Optimizing patient selection for carotid surgery remains an evolving area.
Abstract:
The considerable risks and high costs associated with carotid surgery have raised the discussion of its expediency. Carotid surgery is only indicated if a source of embolism in the region of the carotid bifurcation has been demonstrated or an endangerment of the blood supply to the brain is certain. Methods to detect a source of embolism with some reliability were not available until the advent of high-resolution Doppler ultrasound and transcranial techniques. The demonstration of an endangerment of the blood supply to the brain requires measurement of the regional cerebral blood flow assessment of the collateral circulations, and determination of the reserve capacity of the cerebral blood system. Diagnostic procedures available for this and their clinical relevance are discussed. Reliable assessment, however, requires functional criteria which still have to be developed.
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