• G H Visser, G H Wieneke, A C van Huffelen, and B C Eikelboom.
• Department of Clinical Neurophysiology, University Hospital Rotterdam, The Netherlands.
• Eur J Vasc Endovasc Surg. 2000 Mar 1; 19 (3): 226-32.

Objectivesto analyse whether preoperative transcranial Doppler (TCD) variables can predict intraoperative shunt requirement.Design And Methodsthe blood-flow velocity (BFV) in the major basal cerebral arteries was measured preoperatively with TCD, in 178 patients scheduled for CEA. Carotid artery compression and CO2 reactivity tests were also performed. Intraoperative electroencephalography was used to decide whether a shunt was needed. Differences in the probability of shunt requirement between the categories of variables were assessed with crosstabs statistics.Resultspreoperative TCD criteria clearly identified a subgroup of 59 patients (33%) who did not require a shunt. In general, these patients appeared to have adequate collateral flow through the anterior communicating artery. In contrast, prediction of the need for a shunt was less reliable. TCD variables could predict the need for a shunt with a probability of only 60%.Conclusionspreoperative TCD can be used to identify patients who do not require a shunt during carotid endarterectomy.Copyright 2000 Harcourt Publishers Ltd.

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