Cerebral monitoring during transcarotid artery revascularization with flow reversal via transcranial doppler ultrasound examination.
Aged
Carotid Artery, Common
/ diagnostic imaging
Carotid Stenosis
/ diagnosis
Endarterectomy, Carotid
/ methods
Endovascular Procedures
/ methods
Female
Follow-Up Studies
Humans
Male
Monitoring, Intraoperative
/ methods
Retrospective Studies
Risk Factors
Treatment Outcome
Ultrasonography, Doppler, Transcranial
/ methods
Embolic hits
Flow reversal
Transcarotid artery revascularization (TCAR)
Transcranial Doppler (TCD)
Journal
Journal of vascular surgery
ISSN: 1097-6809
Titre abrégé: J Vasc Surg
Pays: United States
ID NLM: 8407742
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
18
10
2019
accepted:
26
03
2020
pubmed:
26
4
2020
medline:
4
5
2021
entrez:
26
4
2020
Statut:
ppublish
Résumé
Transcarotid artery revascularization (TCAR) is a hybrid technique for carotid artery revascularization that relies on proximal carotid occlusion with flow reversal for distal embolic protection. The hemodynamic response of the intracranial circulation to flow reversal is unknown. In addition, the rate and pattern of cerebral embolization during flow reversal has yet to be investigated. The aim of this study was to characterize cerebral hemodynamic and embolization patterns during TCAR. A single-institution retrospective study of patients with carotid artery stenosis undergoing TCAR with intraoperative transcranial Doppler (TCD) monitoring of the middle cerebral artery (MCA) was performed. Primary outcomes included changes in MCA velocity and MCA embolic signals observed throughout TCAR. Eleven patients underwent TCAR with TCD monitoring of the ipsilateral MCA. The average MCA velocity at baseline was 50.6 ± 16.4 cm/s. MCA flow decreased significantly upon initiation of flow reversal (50.5 ± 16.4 cm/s vs 19.1 ± 18.4 cm/s; P = .02). The reinitiation of antegrade flow resulted in a significant increase in the number of embolic events compared with baseline (P = .003), and embolic events were observed in two patients during flow reversal. TCD monitoring of patients undergoing TCAR revealed that the initiation of flow reversal results in a decrement in ipsilateral MCA velocity. Furthermore, embolic events can occur during flow reversal and are significantly associated with the reinitiation of antegrade flow in the internal carotid artery. However, both of these hemodynamic events were well-tolerated in our cohort. These findings suggest that TCAR remains a safe neuroprotective strategy for carotid revascularization.
Identifiants
pubmed: 32334047
pii: S0741-5214(20)31051-X
doi: 10.1016/j.jvs.2020.03.051
pmc: PMC7577965
mid: NIHMS1587144
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
125-131Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR002554
Pays : United States
Informations de copyright
Copyright © 2020 Society for Vascular Surgery. All rights reserved.
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