Preoperative and postoperative monitoring of the patients with severe internal carotid artery stenosis [Monitoraggio pre e post operatorio dei pazienti con stenosi carotidea critica]

The Authors develop a clinical trial to monitoring the patients with severe internal carotid artery (ICA) stenosis before and after the surgical procedure of thromboendarterectomy (TEA). Preoperative evaluation selects the patients giving hemodynamic information to optimize the surgical indications and defining postoperative prognosis of the patients. Preoperative data include brain CT scan, cardiologic and TSA color coded ultrasonography evaluation (energy color-Doppler) to define morphological characteristics and exact percentage of carotid artery stenosis, transcranial color imaging (TCI) for intracranial vessels (communicating arteries), blood flow velocity and vasogenic reserve. Clinical and technical hemodynamic data are related to cerebral and TSA digital angiography and surgical indications. Intraoperative monitoring is obtained evaluating the residual pressure in ICA after clamping the common carotid artery and transcranial cerebral oximetry. Postoperative monitoring of patients include TSA and transcranial evaluation one, three and six months after surgery. The Authors related clinical characteristics of five patients with ICA stenosis: in some patients bilateral stenosis is present with hemodynamic blood support of cerebral posterior circulation. In this trial the most important data is the lost of cerebral vasogenic reserve also in the other contralateral side in the most severe ICA stenosis. Postoperative recovery of cerebral vasogenic reserve has been good in four patients; in the last patient a further examination after a longer interval of time has been requested. The surgical results has been good in all the cases, without any complications.