• P Belardi, G Lucertini, and D Ermirio.
• Vascular Surgery, Università degli Studi di Genova, Largo Rosanna Benzi 8, 16132 Genoa, Italy.
• Eur J Vasc Endovasc Surg. 2003 Feb 1; 25 (2): 164-7.

Objectivesto compare stump pressure (SP) and transcranial Doppler (TCD) with neurologic monitoring during carotid endarterectomy (CEA).Materialsone hundred and forty-seven CEAs performed under local anaesthesia.Methodsneurologic monitoring and SP were performed in all cases, while mean velocity of the middle cerebral artery (mvMCA) by TCD was done in 140/147 (95%) cases. Shunts were applied in all cases on the basis of neurologic monitoring. The following haemodynamic criteria have been compared to neurologic monitoring: (a) <25 mmHg SP; (b) <50 mmHg SP; (c) < or =10 cm/s mvMCA after carotid occlusion; (d) > or =70 decrease of mvMCA after carotid occlusion. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for each haemodynamic criterion.Resultsshunt was used in 18/147 (12.2%) cases. With regards to <25 mmHg SP, < or =50 mmHg SP, < or =10 cm/s mvMCA after carotid occlusion, and > or =70 decrease of mvMCA after carotid occlusion, sensitivity resulted 33, 89, 80 and 80%, respectively. Specificity resulted 96, 82, 97 and 96%, respectively. Positive predictive value resulted 55, 41, 75 and 71%, respectively. Negative predictive value 91, 98, 98 and 98%, respectively. Accuracy resulted 88, 76, 89 and 94%, respectively.Conclusionsnone of the haemodynamic criteria by SP and TCD resulted absolutely reliable in predicting the need for carotid shunt.

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