Can Cerebral Vasoreactivity Predict Cerebral Tolerance to Carotid Clamping during Carotid Endarterectomy?

Abstract

Cerebral vasoreactivity (CVR) was evaluated as a preoperative test in predicting cerebral tolerance to carotid clamping. A consecutive series of 115 carotid endarterectomy (CEA) cases were studied. Before surgical operation CVR was evaluated, by measuring the mean velocity of the middle cerebral artery (mv-MCA) using transcranial Doppler (TCD) at the basal condition and 20 min after intravenous administration of acetazolamide (1 g). CEA was performed under general anesthesia. TCD was used during surgery to evaluate mv-MCA and to calculate mv-MCA clamping/mv-MCA pre-clamping x100 ratio (mv-MCA%), which was used as the parameter to validate CVR. CVR did not correlate with mv-MCA% ( r = 0.22). There was no significant difference ( P= 0.09) between mean values of the non shunted subgroup and the shunted one. CVR does not seem to be suitable for evaluating cerebral tolerance to carotid clamping.