Changes in Blood Flow Velocity of the Middle Cerebral Artery After Carotid Endarterectomy: Daily Assessment with Transcranial Color-Coded Sonography.

BACKGROUND: Hyperperfusion syndrome (HPS) is a well-known complication of carotid endarterectomy (CEA) warranting repeatable inexpensive monitoring. Transcranial color-coded sonography (TCCS) may provide a potential modality for such monitoring, but little is known about TCCS trends after CEA.

METHODS: Between January 2016 and February 2017, we prospectively included patients with CEA at our institute in this study. TCCS was performed preoperatively and repeated daily from the operation day until postoperative day (POD) 7. Daily trends in mean flow velocity (MFV) at the M1 portion of the middle cerebral artery were compared between patients with and without HPS.

RESULTS: Among 35 patients with CEA, daily TCCS monitoring was performed in 18 patients (mean age ± SD, 72 ± 7 years; male/female, 17:1). Among these 18 patients, 3 had probable HPS. On POD 0, MFV of the 18 patients showed a 32% increase from the initial preoperative value (from 52.5 to 69.4 cm/s, P = 0.0013). This increased MFV lasted for several days and recovered gradually by POD 7. Patients with probable HPS demonstrated a trend to higher MFV than those without; however, the difference was below the significance level.

CONCLUSIONS: We used daily TCCS after CEA to depict cerebral blood flow changes after CEA in our cohort. This technique may be useful both for the detection and prevention of HPS.