TCD-Guided management in carotid endarterectomy: a retrospective study

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.