Transcranial Doppler monitoring during carotid endarterectomy helps to identify patients at risk of postoperative hyperperfusion

Objectives: to investigate whether transcranial Doppler (TCD) monitoring can identify patients at risk of hyperperfusion and whether active postoperative treatment of selected patients decreases the risk of intracerebral haemorrhage (ICH). Design: a case cohort study of 688 patients undergoing carotid endarterectomy (CEA) with intraoperative TCD monitoring. Methods: sixty-two patients (9%) fulfilled the TCD criteria for hyperperfusion, i.e. >100% increase of peak blood flow velocity or pulsatility index of the middle cerebral artery, compared to preclamp baseline values. In these patients, blood pressure was closely monitored and controlled postoperatively. Results: postoperatively, seven of these patients (11%) exhibited clinical signs or symptoms of hyperperfusion but no cerebral haemorrhage (ICH). This is a significantly better outcome (p<0.005) compared to a 2% incidence of ICH after CEA in previous years in our hospital. Conclusions: patients at risk at hyperperfusion syndrome after CEA can be identified intraoperatively by TCD monitoring. In these selected patients, immediate and adequate postoperative treatment of hypertension results in a decreased risk of intracerebral haemorrhage.