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Intraoperative Monitoring

Intraoperative TCD is performed during carotid endarterectomy and cardiac surgery. Monitoring the MCAs gives real-time data on cerebral hemodynamics, which may change dramatically during these surgeries with resultant neurological complications. This technique provides early warning of blood flow decreases, emboli and hyperperfusion, the knowledge of which will impact surgical technique, blood pressure control and medical therapy in the intra- and post-operative phases. TCD monitoring gives the surgical team a better understanding of the causes of neurological complications and can reduce the risk of these events occurring. Decisions relative to cardiopulmonary bypass techniques, manipulation of vessels, to clamp or shunt during endarterectomy and anesthetic control of blood pressure are facilitated by the flow information obtained using the TCD.

The middle cerebral artery is continuosly monitored during carotid endarterectomy and in the post operative recovery room to detect changs in flow and emboli. "Click" on above image to view larger.	MCA flow velocity decreases with surgical cross clamping of the ICA during endarterectomy. The percent drop in velocity helps the surgeon choose clamping versus shunting techniques.
	Emboli detected during carotid surgery and in the recovery room wll infuence surgical tecnique and medical therapy.