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HMAA 2013

Transcranial Doppler (TCD): The premier multidimensional monitoring modality for carotid interventions
by

Adrien Rácz

on 20 November 2013

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Transcript of HMAA 2013

Comparative Magnetic Resonance Imaging (MRI) study of the brain in patients after carotid artery stenting (CAS) and carotid endarterectomy (CEA)
CAS
CEA
Adrien Racz, 6th year med. student
Nandor Pinter MD
Semmelweis University, Heart Center, Budapest, HU
- digital substraction angiography (DSA)
- percutaneous transluminal
angioplasty (PTA): balloon, stent
- narcosis
- invasive
- ICA clamped
- endarterectomy

Clinical importance:
TIA, stroke, multifocal ischemic lesions, mortality



Diagnosis: noninvasive imaging



Therapy: CEA or CAS
CAS vs . CEA


>amount:
CEA:2
CAS:38

> extent: 2-6mm
New ischemic lesions
Distribution of patients by new ischemic lesions
Etiology: atherosclerosis
Patients
No. of isch. lesions
embolus
Presence

Depth

Direction

Speed

Resistance
Clamp on
w shunt
w/o shunt
clamp
off
clamp
off
Transcranial Doppler (TCD): The premier multidimensional monitoring modality for carotid interventions
Adrien Rácz, Gábor Rosta, Zsolt Garami
Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center,
The Methodist Hospital – Houston, TX

Postoperative imaging

New challenge:
Intraoperative imaging
Shunt or not to shunt?
Shunt
Clamp on: Mean flow velocity (MFV) drops

No shunt
Embolization by

shunting
Intracranial circulation
Real-time hemodynamic information
Red: towards you, blue: away from you




Emboli detection
TCD
Our study:
Real-time decision making during carotid endarterectomy (CEA)

-Beside emboli detection
-Guiding our CEAs:
»Shunt placement needed?



»Improvement of procedure time, bleeding

Conclusion


-Monitoring wrong vessel



-Terminal ICA occlusion-inoperable

Pitfalls

-1 postoperative stroke, MRI: watershed lesion
-1 hyperperfusion
-3 MCA MFV didn’t improve
Angiography in these cases
»2 reoperation
»1 distal ICA occlusion


Results

-102 patients, 78 male, 24 female,
average age: 68 y
-Right ICA: 54, Left ICA: 48
-Established need for shunt: 50% MFV drop


Our study

»41% shunted
Thank you for your attention!
p‹0.05
p‹0.05
Full transcript