Application value of transcranial Doppler combined with indocyanine green angiography and FLOW 800 in carotid endarterectomy / 中华神经医学杂志

ABSTRACT

Objective To investigate the hemodynamic monitoring and clinical significance of transcranial Doppler (TCD) combined with indocyanine green (ICG) fluorescence angiography and FLOW 800 in carotid endarterectomy (CEA).Methods Forty-eight patients with extracranial carotid atherosclerotic stenosis underwent CEA in our hospital from October 2015 to September 2018 were chosen to our study. The mean blood flow velocity (Vm) of the middle cerebral artery (MCA) was monitored by TCD throughout the operation. The intraoperative blood pressures were adjusted according to the monitoring results, and the average blood Vm of the narrowed arteries was measured using TCD probe before and after artery temporary occlusion. ICG fluorescence angiography and FLOW 800 were used to monitor vascular morphology and patency simultaneously.Results One patient, who was observed to have severe stenosis by TCD, ICG fluorescence angiography, and FLOW 800 after arteries temporary occlusion, showed significantly improved by multimodal monitoring after re-suture; one patient showed external carotid artery occlusion by ICG fluorescence angiography and FLOW 800 had noexternal carotid artery occlusion; other 46 patients showed no carotid artery stenosis and good intracranial perfusion by TCD, ICG fluorescence angiography, and FLOW 800 after initial suture. Two patients developed ischemic stroke (IS) after CEA, and both of them were recovered after conservative medical treatment for two weeks without any neurological dysfunction; two patients had cerebral hyperperfusion syndrome (CHS), and both of them relieved after blood pressure control three d after treatment; one patient had subcutaneous hematoma in the operation area, and the hematoma was gradually absorbed after conservative treatment; the rest patients recovered well. All patients were followed up for 4-6 months after CEA, and CT angiography showed that carotid artery stenosis was relieved; CT perfusion imaging and TCD examinations showed that cerebral perfusion was significantly improved as compared with those before operation.Conclusion Intraoperative TCD combined with ICG fluorescence angiography and FLOW 800 can effectively monitor the intracranial and extracranial blood flow of intraoperative carotid artery, which is of great significance in reducing the risk of IS and CHS during carotid endarterectomy.