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”QC is not the same as monitoring. The role of monitoring is to ensure adequate brain perfusion, (especially during clamping or shunting), using TCD, CEA under LRA, stump pressure, ICA backflow or near infrared spectroscopy. Loss of cerebral electrical activity is assessed by somatosensory evoked potentials (SSEPs) or EEG. The aim of QC is to identify and correct technical error, such as embolisation during carotid mobilisation (TCD), ensuring the shunt isfunctioning (TCD, CEA under LRA), identifying luminal thrombus before flow restoration (angioscopy), identifying luminal thrombus after flow restoration (DUS, angiography), diagnosing intimal flaps (angioscopy, DUS, angiography), diagnosing residual stenoses (DUS, angiography) and diagnosing the rare patient thrombosing the operated ICA during neck closure (increasing embolisation followed by declining MCA velocities on TCD).”
The authors refer to the Meta-analysis by Knappich C et al. published in 2021 as the basis for this new recommendation.
Recommendation 77 (New)
“For patients undergoing carotid endarterectomy, intra-operative completion imaging with angiography, duplex ultrasound or angioscopy should be considered in order to reduce the risk of peri-operative stroke.”
Class IIa, Level B
