On-table diagnosis of incipient carotid artery thrombosis during carotid endarterectomy by transcranial Doppler scanning Michael E. Gaunt, FRCS, David.

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Presentation transcript:

On-table diagnosis of incipient carotid artery thrombosis during carotid endarterectomy by transcranial Doppler scanning Michael E. Gaunt, FRCS, David A. Ratliff, MD, FRCS, Peter J. Martin, MA, MRCP, Julia L. Smith, BSc, Peter R.F. Bell, MD, FRCS, A.Ross Naylor, MD, FRCS Journal of Vascular Surgery Volume 20, Issue 1, Pages 104-107 (July 1994) DOI: 10.1016/0741-5214(94)90181-3 Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 TCD scanning printouts show MCA velocity changes and detection of emboli at different stages of operation (emboli are high-intensity signals within Doppler envelope and are indicated by arrow s). A, Start of operation. Average velocity = 48 cm/sec. B, Carotid artery clamped. Average velocity = 24 cm/sec. C, Shunt opened. Average velocity = 42 cm/sec. D, Flow restored through carotid artery. Average velocity = 68 cm/sec. First embolus noticed. E, MCA velocity falling to 54 cm/sec. More emboli. F, MCA velocity falling to 43 cm/sec. More emboli. G, Artery is nearly occluded. Average velocity = 27 cm/sec. Emboli are still occurring. H, Reopening neck. Handling ICA provokes numerous emboli followed by velocity increase from 26 to 40 cm/sec. I, Injection of contrast during on-table arteriography causes severe flow disturbance. J, End of operation. Average velocity = 57 cm/sec. Maintained after operation. Journal of Vascular Surgery 1994 20, 104-107DOI: (10.1016/0741-5214(94)90181-3) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 TCD scanning printouts show MCA velocity changes and detection of emboli at different stages of operation (emboli are high-intensity signals within Doppler envelope and are indicated by arrow s). A, Start of operation. Average velocity = 48 cm/sec. B, Carotid artery clamped. Average velocity = 24 cm/sec. C, Shunt opened. Average velocity = 42 cm/sec. D, Flow restored through carotid artery. Average velocity = 68 cm/sec. First embolus noticed. E, MCA velocity falling to 54 cm/sec. More emboli. F, MCA velocity falling to 43 cm/sec. More emboli. G, Artery is nearly occluded. Average velocity = 27 cm/sec. Emboli are still occurring. H, Reopening neck. Handling ICA provokes numerous emboli followed by velocity increase from 26 to 40 cm/sec. I, Injection of contrast during on-table arteriography causes severe flow disturbance. J, End of operation. Average velocity = 57 cm/sec. Maintained after operation. Journal of Vascular Surgery 1994 20, 104-107DOI: (10.1016/0741-5214(94)90181-3) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Intraoperative carotid arteriogram shows severe stenosis of proximal internal carotid artery caused by thrombus formation after final restoration of flow. B, Completion intraoperative carotid arteriogram shows complete removal of thrombus. Journal of Vascular Surgery 1994 20, 104-107DOI: (10.1016/0741-5214(94)90181-3) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 A, Intraoperative carotid arteriogram shows severe stenosis of proximal internal carotid artery caused by thrombus formation after final restoration of flow. B, Completion intraoperative carotid arteriogram shows complete removal of thrombus. Journal of Vascular Surgery 1994 20, 104-107DOI: (10.1016/0741-5214(94)90181-3) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions