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Recognising stroke prone patients with a poor collateral circulation.

B C Eikelboom¹, R J Welten, R G Ackerstaff

¹Department of Surgery, St. Antonius Hospital, Nieuwegein-Utrecht, The Netherlands.

European Journal of Vascular Surgery

|December 1, 1987

Summary

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Identifying patients with poor collateral circulation in carotid disease is crucial. Non-invasive tests like OPG and EEG can help recognize individuals at higher stroke risk, aiding surgical decisions.

Area of Science:

Neurology
Vascular Surgery
Diagnostic Imaging

Background:

Prognosis in carotid artery disease varies significantly, influenced by collateral circulation.
Identifying patients with compromised collateral flow is essential for stroke risk stratification.
Non-invasive methods are sought to predict collateral potential preoperatively.

Purpose of the Study:

To evaluate the efficacy of non-invasive tests in identifying patients with poor collateral circulation during carotid endarterectomy.
To compare the diagnostic accuracy of preoperative Ocular Pneumoplethysmography (OPG) and Electroencephalography (EEG) with intraoperative findings.
To determine if these tests can refine indications for carotid endarterectomy.

Main Methods:

A prospective study involving 208 patients undergoing carotid endarterectomy.

Related Experiment Videos

Preoperative OPG and EEG were performed.

Intraoperative EEG during test clamping was used as a reference standard to detect clamping ischemia.

Sensitivity and specificity of OPG and EEG were calculated.

Main Results:

Clamping ischemia occurred in 14% of patients.
Preoperative EEG showed 62% sensitivity and 82% specificity.
OPG demonstrated 96% sensitivity and 54% specificity.
Combined OPG and EEG yielded 93% sensitivity and 73% specificity.
Both tests were found to be safe and easy to perform.

Conclusions:

Non-invasive tests, particularly OPG, can effectively identify patients with carotid stenosis at increased risk of stroke due to poor collateral circulation.
Combined OPG and EEG offer a valuable tool for risk stratification.
These findings may help optimize the selection of patients for carotid endarterectomy.