What are the applications of transcranial Doppler ultrasound and somatosensory evoked potential in carotid endarterectomy?
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Transcranial Doppler ultrasound (TCD) and somatosensory evoked potential (SEP) have several applications in carotid endarterectomy (CEA). TCD can be used to monitor blood velocity signals during CEA and carotid artery stenting (CAS) . It can also be used to evaluate occlusive cerebrovascular diseases (CVDs), assess collateral circulation in patients with ischemic stroke, and monitor cerebral vascular occlusion before and after thrombolysis . SEP monitoring with TCD can help in predicting the need for an intraoperative shunt and temporary postoperative deficits . Additionally, paired-pulse SEPs, in combination with conventional SEPs, can identify transient, persistent, or permanent neuronal imbalances during CEA, providing better ischemic monitoring . Doppler ultrasound analysis of the ophthalmic artery (OA) and anterior cerebral artery (ACA), along with analysis of internal carotid artery (ICA) stenosis, may be a promising predictor of neurologic symptoms during ICA clamping, helping to warn patients and surgeons of increased risk during surgery .
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1 Citations | The provided paper does not mention the applications of transcranial Doppler ultrasound and somatosensory evoked potential in carotid endarterectomy. |
9 Citations | The provided paper does not mention the applications of transcranial Doppler ultrasound and somatosensory evoked potential in carotid endarterectomy. |
4 Citations | The applications of transcranial Doppler ultrasound and somatosensory evoked potential in carotid endarterectomy include monitoring for the need for intraoperative shunting and predicting temporary postoperative deficits. |
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What are the benefits of using stump pressure monitoring during carotid endarterectomy?4 answersStump pressure monitoring during carotid endarterectomy provides several benefits. It can help determine the need for a carotid artery shunt. By comparing the carotid stump pressure values between patients who needed shunting and those who did not, it can identify the patients who require a shunt. In addition, carotid stump pressure has been found to have sufficient diagnostic power in determining the need for a shunt. However, it is important to note that carotid stump pressure alone cannot be used in the clinical setting and should be used in combination with other neurological monitoring methods. Other monitoring techniques, such as neurophysiologic techniques including electroencephalography, somatosensory evoked potentials, and transcranial motor evoked potentials, can also be used to detect and reverse cerebral ischemia during carotid endarterectomy.
What are the potential risks associated with intraoperative transcranial Doppler ultrasound monitoring in carotid endarterectomy?5 answersIntraoperative transcranial Doppler ultrasound monitoring in carotid endarterectomy (CEA) carries potential risks. The clamping of the internal carotid artery (ICA) during CEA can lead to cerebral hypoperfusion, which may result in the development of neurologic symptoms (NS). Additionally, the use of transcranial Doppler (TCD) in the multimodality approach for monitoring cerebral blood flow can detect microemboli that may cause a stroke. However, TCD monitoring of cerebral blood flow may not be superior to neurological symptoms in detecting the need for a shunt during CEA. In contrast, somatosensory evoked potential (SEP) monitoring has shown promise in predicting the need for an intraoperative shunt and temporary postoperative deficits. Further studies are needed to evaluate the effectiveness and safety of TCD monitoring in CEA.
How accurate are somatosensory evoked potentials in predicting cerebral ischemia during carotid endarterectomy?4 answersSomatosensory evoked potentials (SEPs) have shown promise in predicting cerebral ischemia during carotid endarterectomy (CEA). SEPs can reliably identify transient, persistent, or permanent neuronal imbalances, depending on the severity of ischemia. In a study of CEA patients, SEPs demonstrated significant differences in amplitude ratios between patients with and without immediate postoperative neurologic deficits, indicating their potential for predicting the need for intraoperative shunting and temporary postoperative deficits. Another study found that an incomplete circle of Willis and contralateral internal carotid artery (ICA) occlusion were associated with alterations in SEPs during CEA, suggesting that preoperative assessment of collateral arterial anatomy could help identify patients at increased intraoperative risk. These findings suggest that SEPs can be accurate in predicting cerebral ischemia during CEA and may provide valuable information for surgical decision-making and patient outcomes.
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