Abstract：
BACKGROUND: Carotid endarterectomy is routinely performed after ischemic stroke due to carotid stenosis. Perioperative, cerebral blood flow and oxygenation can be monitored in different ways, but there is no clear evidence of a gold standard and a uniform guideline is lacking. Electroencephalography and near-infrared spectroscopy are among the most frequently used methods of neuromonitoring. Clinicians should be aware of their pitfalls and the added value of transcranial doppler.
METHODS: We present the case of an 85-year old male with perioperative haemodynamic stroke during carotid endarterectomy. Ischemic stroke was caused by suddenly increased carotid stenosis resulting in major neurologic deficit. This was registered only by transcranial doppler, while surface electroencephalography and near-infrared spectroscopy failed to detect any significant change in cerebral perfusion, despite a large perfusion defect on computed tomography. Circulation was restored with endovascular treatment and neurologic deficit quickly resolved.
CONCLUSIONS: We strongly advocate the practice of multimodal neuromonitoring including transcranial doppler whenever possible to minimize the risk of persistent neurologic deficit due to perioperative stroke during carotid endarterectomy.
METHODS: We present the case of an 85-year old male with perioperative haemodynamic stroke during carotid endarterectomy. Ischemic stroke was caused by suddenly increased carotid stenosis resulting in major neurologic deficit. This was registered only by transcranial doppler, while surface electroencephalography and near-infrared spectroscopy failed to detect any significant change in cerebral perfusion, despite a large perfusion defect on computed tomography. Circulation was restored with endovascular treatment and neurologic deficit quickly resolved.
CONCLUSIONS: We strongly advocate the practice of multimodal neuromonitoring including transcranial doppler whenever possible to minimize the risk of persistent neurologic deficit due to perioperative stroke during carotid endarterectomy.
摘要：
背景：颈动脉内膜切除术通常在颈动脉狭窄引起的缺血性卒中后进行。围手术期,脑血流量和氧合可以用不同的方式监测，但是没有明确的黄金标准证据，也缺乏统一的指导方针。脑电图和近红外光谱法是最常用的神经监测方法之一。临床医生应该意识到他们的陷阱和经颅多普勒的附加值。
方法：我们介绍了一例85岁男性在颈动脉内膜切除术中出现围手术期血流动力学卒中的病例。缺血性中风是由突然增加的颈动脉狭窄引起的，导致严重的神经功能缺损。这只通过经颅多普勒记录，而表面脑电图和近红外光谱未能检测到脑灌注的任何显著变化，尽管计算机断层扫描有很大的灌注缺陷。血管内治疗可恢复循环，神经功能缺损迅速解决。
结论：我们极力主张采用多模式神经监测，包括经颅多普勒，以尽可能降低颈动脉内膜切除术期间由于围手术期中风引起的持续性神经功能缺损的风险。
方法：我们介绍了一例85岁男性在颈动脉内膜切除术中出现围手术期血流动力学卒中的病例。缺血性中风是由突然增加的颈动脉狭窄引起的，导致严重的神经功能缺损。这只通过经颅多普勒记录，而表面脑电图和近红外光谱未能检测到脑灌注的任何显著变化，尽管计算机断层扫描有很大的灌注缺陷。血管内治疗可恢复循环，神经功能缺损迅速解决。
结论：我们极力主张采用多模式神经监测，包括经颅多普勒，以尽可能降低颈动脉内膜切除术期间由于围手术期中风引起的持续性神经功能缺损的风险。
