Transcranial Doppler ultrasonography (TCD) has been used to measure CBF velocity in the ipsilateral middle cerebral artery during carotid endarterectomy. Although the technique is well established, due to variations in normal vessel diameter and operator technique, TCD can provide only a relative index of CBF
CEREBRAL BLOOD FLOW: PHYSIOLOGY AND MEASUREMENT TECHNIQUES
based on normal ranges. As equipment and operator experience have developed, the technique has been used more frequently in intraoperative monitoring. TCD variables may accurately predict stroke during or immediately following carotid endarterectomy. Furthermore, TCD may identify patients at risk for post-endarterectomy hyperperfusion syndrome and hemorrhage with high sensitivity. While the technique has the advantage of being non-invasive, the cost-effectiveness of TCD monitoring during carotid endarterectomy remains unknown.
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