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Updated: Jun 11, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
TCD-Guided management in carotid endarterectomy: a retrospective study
Na Yang1, Qinghong Wang1, Hongmei Qi1
1Ultrasound Department, Jinan People's Hospital, Jinan, Shandong Province, China.
Insights
Transcranial Doppler (TCD) ultrasound monitoring during carotid endarterectomy (CEA) significantly reduced surgery duration and artery occlusion time. This technique may also decrease postoperative complications, aiding personalized surgical planning for stroke prevention.
Area of Science:
- Vascular Surgery
- Neurology
- Medical Ultrasound
Background:
- Stroke is a leading cause of death and disability, often linked to carotid artery stenosis.
- Carotid endarterectomy (CEA) is a primary treatment, but carries risks of cerebral ischemia.
- Transcranial Doppler (TCD) ultrasound offers noninvasive monitoring during CEA.
Purpose of the Study:
- To evaluate the clinical utility and safety of TCD monitoring during CEA.
- To identify factors predicting postoperative complications in CEA patients.
- To assess the impact of TCD on surgical outcomes and patient safety.
Main Methods:
- Retrospective analysis of 158 CEA patients with TCD monitoring vs. historical controls.
- Comparison of operation duration, artery occlusion time, shunt usage, and postoperative complications.
- Logistic regression and ROC curve analysis to identify predictive factors for adverse events.
Main Results:
- TCD monitoring significantly reduced surgery duration (113.26 min) and occlusion time (21.85 min) (P < 0.001).
- Increased carotid shunt usage (25%) observed with TCD monitoring.
- Postoperative complications were low (1%) with a favorable trend for TCD; plaque echogenicity was a significant predictor (OR = 10.70, P = 0.02).
Conclusions:
- TCD monitoring in CEA may shorten procedure times and potentially reduce postoperative complications.
- TCD facilitates personalized surgical planning for improved CEA outcomes.
- Plaque echogenicity is a key factor in predicting postoperative issues during CEA.
Abstract:
BACKGROUNDː: Stroke, primarily resulting from ischemic conditions, is the foremost cause of mortality and long-term impairment and is frequently associated with narrowing of the carotid arteries. Although carotid endarterectomy (CEA) is the treatment of choice, it carries the risk of cerebral ischemia and reduced blood flow. Transcranial Doppler (TCD) ultrasound offers a nonintrusive method to assess cerebral blood circulation during CEA, potentially enhancing surgical outcomes. The objective of this study was to assess the clinical utility and safety of TCD monitoring during CEA and to identify factors influencing postoperative complications. METHODS: This retrospective analysis included 158 CEA patients (from January 2021-August 2023) who underwent TCD monitoring and whose data were compared to historical standard care data. The primary outcomes were operation duration and artery occlusion time. Secondary outcomes included carotid shunt usage, seven-day postoperative complications, and six-month carotid artery patency. Logistic regression identified factors linked to adverse reactions, and a predictive model was evaluated with a receiver operating characteristic (ROC) curve. RESULTSː: Comparative analysis indicated significant reductions in both the duration of surgery (113.26 ± 7.29 min) and artery occlusion time (21.85 ± 2.92 min) for patients monitored with TCD (P < 0.001) and an increase in carotid shunt implementation (25% as opposed to traditional care). The observed postoperative complications were minor, with a nonsignificant trend that favored the use of TCD-monitored procedures (1% vs. historical rates). Factors such as patient age and plaque echogenicity were found to be predictive of postoperative issues, with plaque echogenicity emerging as a significant predictive factor (OR = 10.70, 95% CI: 2.14-202, P = 0.02) upon multivariate analysis. The predictive model exhibited high precision (AUC = 0.93). CONCLUSION: This retrospective evaluation suggested that TCD monitoring in the CEA may reduce procedural time and potentially decrease postoperative complications, supporting its use for personalized surgical planning.
