The increased demand to avoid surgical and neurological complications in carotid surgery calls for meticulous peroperative monitoring. The authors combine Transcranial Doppler (TCD) of ipsilateral middle cerebral artery blood flow measurements with stump pressure (SP). Along with these methods direct dopplerometry (DD) of the exposed vessels prior and after microendarterectomy (CEA) is employed. Since 9/96 through 9/97 68 surgeries in 57 patients have been monitored by at least 2 of the above mentioned techniques. In 35 CEAs all 3 methods have been used. In 17 CEAs a shunt was indicated. TCD and SP correlated in 85%. The morbidity was 1.47% (1 mild stroke, Rankin Scale 1), the mortality was 0%. DD assists the technical control of CEA. Both TCD and SP enable the selective use of shunting based on 2 independent methods. The authors are convinced that combined monitoring decreases the surgical risk as compared with the use of one method only.

        Key words: carotid endarterectomy, direct dopplerometry, transcranial Doppler, stump pressure