Identification of patients at risk for ischaemic cerebral complications after carotid endarterectomy with TCD monitoring

OBJECTIVES: Transcranial Doppler (TCD) monitoring for micro embolic signals (MES), directly after carotid endarterectomy (CEA) may identify patients at risk of developing ischaemic complications. In this retrospective multicentre study, this hypothesis was investigated. METHODS: Centres that monitored for MES after CEA were identified by searching Medline. Individual patient data were obtained from centres willing to collaborate. The number of emboli in 1h was computed. Uni- and multivariate logistic regression analyses were performed for the variables gender, age and number of MES. Discriminative ability of MES monitoring was investigated in a ROC curve. RESULTS: Nine hundred and ninety-one patients were monitored in the first 3h after CEA. Two percent developed ischaemic cerebral complications. Univariate analysis revealed statistically significant associations between ischaemic cerebral complications and both gender and MES, but not age. In a multivariate analysis, > or =8 MES/h showed a statistically significant relationship with cerebral complications (OR 8.1, 95% CI 1.8-36), in contrast to gender (OR 2.2, 95% CI 0.9-5.5). The ROC curve yielded an AUC of 0.83 for monitoring of MES. CONCLUSIONS: These results support the use of TCD monitoring for MES shortly after CEA in order to identify patients at risk of developing ischaemic cerebral complications