Related Experiment Videos
Cerebral microembolism during carotid endarterectomy
T Gavrilescu1, V L Babikian, N L Cantelmo
1Department of Neurology, Boston University School of Medicine, Massachusetts, USA.
American Journal of Surgery
|August 1, 1995
Summary
Carotid endarterectomy poses intraoperative risks of cerebral microembolism. High-intensity transient signals (HITS) indicate this risk, particularly during shunting, unclamping, and wound closure.
Area of Science:
- Neurology
- Vascular Surgery
- Medical Instrumentation
Background:
- Cerebral microembolism is a potential risk during carotid endarterectomy.
- Transcranial Doppler ultrasonography is used to detect intraoperative microembolic events.
Purpose of the Study:
- To assess the intraoperative risk of cerebral microembolism during carotid endarterectomy.
- To identify specific periods of increased risk using high-intensity transient signals (HITS).
Main Methods:
- Thirty-six patients undergoing carotid endarterectomy were monitored.
- Specialized instrumentation detected high-intensity transient signals (HITS) in the middle cerebral artery.
- HITS were analyzed for formed-element and air microbubble characteristics.
Main Results:
- The incidence of HITS increased significantly at clamp release and during shunt opening.
- HITS were also frequently detected during wound closure and shunting.
- Air microbubble HITS were observed at clamp release and shunt opening.
Conclusions:
- Cerebral microembolism events, indicated by HITS, are not random during carotid endarterectomy.
- Shunting, unclamping, and wound closure represent high-risk periods for microembolism.
- Continuous monitoring with transcranial Doppler can identify these critical phases.