Role of Doppler Ultrasound Analysis of Blood Flow Through the Ophthalmic and Intracranial Arteries in Predicting Neurologic Symptoms During Carotid Endarterectomy

Abstract

Objectives Carotid endarterectomy (CEA) is frequently performed under locoregional anesthesia. The intraoperative clamping of the internal carotid artery (ICA) leads to cerebral hypoperfusion, which may in some patients result in the development of neurologic symptoms (NS). The objective of our study was to investigate whether there is an association between the preoperative ultrasound (US) Doppler flow in the ophthalmic artery (OA) and intracranial artery and the occurrence of these intraoperative NS. Methods We compared 50 patients with NS and 150 patients without NS during CEA. We analyzed their preoperative blood flow characteristics by Doppler US and their clinical and demographic characteristics. Results The contralateral ICA occlusion increased the likelihood of intraoperative NS (odds ratio [OR], 8.4; P < .001). Abnormal contralateral OA flow also increased the likelihood of NS (OR, 1.84; P < .001), whereas ipsilateral abnormal OA flow reduced it (OR, 0.73; P = .06). Increased flow in the ipsilateral anterior cerebral artery (ACA) increased the likelihood of NS (OR, 3.3), whereas reversed flow decreased it (OR, 0.1; P = .03). Inverse flow in the contralateral ACA increased the risk (OR, 5.4), whereas increased flow reduced it (OR, 0.2; P = .02). Male patients had a higher risk of NS (P = .09) as well as older patients (P = .05). Eight percent of the patients with NS developed a transient ischemic attack or stroke. Conclusions Doppler US analysis of the OA and ACA in combination with analysis of ICA stenosis may be a promising predictor of NS during ICA clamping. This, in turn, may warn the patient and the surgeon of an increased risk during surgery.

Decreased Ocular Perfusion Pressure Associated With Reverse Ophthalmic Artery Flow on Transcranial Doppler Ultrasonography

“…Hence, this reverse flow can serve as an important clinical sign of impaired cerebral hemodynamics and vasomotor reactivity [ 3 , 7 ]. In addition, stroke patients with ROAF have been reported to have worse outcomes than patients without ROAF [ 4 , 8 ]. When one segment of neurological tissue is in a compromised hemodynamic state, it redirects blood flow from ocular tissue, resulting in ROAF and a decrease in OPP [ 9 , 10 ].…”

Ophthalmic artery flow direction change predicts recurrence of ischemic stroke after carotid stenting: a longitudinal observational study

“…In particular, significant differences were found in changes in stenosis levels and plaque enhancement between patients with/without stroke recurrence, and the changes showed correlations between stenosis and plaque enhancement, as well as with subsequent recurrent stroke [ 16 ]. Previous studies have also reported that reversal of ophthalmic artery before carotid stenting is associated with poorer prognosis [ 3 , 4 , 7 ]. However, high risk for recurrent ischemic stroke in patients with carotid stenosis post stenting phase is yet to be investigated.…”

“…The incidence of reversed ophthalmic artery flow is higher in patients with severe carotid stenosis and acute stroke [ 3 – 6 ]. Stroke patients with reversed ophthalmic artery flow are reported to have worse outcomes than those without [ 3 , 4 , 7 ], while patients with MCA stenosis and reversed ophthalmic artery flow have higher risk of stroke recurrence [ 3 ]. In posterior circulation stroke, the prevalence of basilar artery/vertebral artery (BA/VA) stenosis > 50% is 20–30% in patients with ischemic stroke or transient ischemic attack, and BA/VA stenosis is also associated with recurrent stroke and mortality in these patients [ 8 – 11 ].…”