The goal of this observational study is to learn whether continuous carotid artery blood flow signals can be recorded reliably during surgery, and whether Vibrant Medical's analysis method can detect measurable changes in those signals, in adults undergoing elective carotid endarterectomy (CEA). During CEA, the surgeon temporarily clamps the internal carotid artery as a routine part of the operation. This produces a brief, controlled and fully reversible stop in blood flow that resembles the blood flow change seen in a large-vessel ischemic stroke.
The main questions it aims to answer are:
* Can usable, continuous blood flow signals be recorded from both sides of the neck before and during carotid clamping? * Do the recorded signals show consistent, repeatable changes that are time-locked to carotid clamping and release across patients?
Participants will have their scheduled surgery as usual. During surgery, two legally marketed, FDA-cleared diagnostic ultrasound systems will record blood flow from the common carotid artery on each side of the neck, before clamping, during clamping and after the clamp is released, for about 20 to 30 minutes in total. The recordings are analyzed later and are not seen or used by the surgical team. No part of the surgery or anesthesia care is changed, and there are no study visits after surgery.
Adult patients 18 years of age or older.
Scheduled to undergo elective unilateral carotid endarterectomy.
Capable of providing written informed consent pre-operatively.
No condition precluding placement of an ultrasound transducer at either side of the neck, as determined by the Investigator.
Emergency or urgent (non-elective) carotid endarterectomy.
Planned simultaneous bilateral carotid endarterectomy, which would prevent contralateral recording.
Known active neck wound, infection, or skin condition at the intended device application site.
Implanted active device at the neck (e.g., vagal nerve stimulator) that could be affected by external ultrasound.
Adult patients (18 years or older) scheduled for elective unilateral carotid endarterectomy at Tampa General Hospital, identified by the treating surgical team from the elective operative schedule and approached during a routine pre-surgical encounter.
Case-only
Prospective
Bilateral carotid Doppler signal acquisition (Vibrant Stroke Detection Technology)
DeviceExternal, non-invasive recording of common carotid artery flow on both sides of the neck using two legally marketed, FDA-cleared Class II diagnostic ultrasound systems, one per side, each used within its cleared Peripheral Vessel indication: Telemed ArtUs EXT-2H with L12-5N40-A4 transducer (510(k) K211248) and Telemed SmartUs EXT-1M with L15-7L40H-5 transducer (510(k) K163121). Recordings are analyzed offline with Vibrant Medical research software (For Research Use Only). No output is shown to the surgical team and no clinical decision is based on the recordings.
Percentage of Subjects With Successful Bilateral Carotid Signal Acquisition During Baseline and Internal Carotid Artery Clamping
A subject is counted as a success when usable, continuous bilateral common carotid flow signal is acquired for the full duration of Phase 1 (pre-clamp baseline) and Phase 2 (internal carotid artery clamping), adjudicated against signal-quality criteria fixed before the first subject is enrolled. Subjects in whom acquisition fails are retained in the denominator. Reported as the percentage of enrolled subjects with an exact (Clopper-Pearson) 95% confidence interval, against a descriptive benchmark of at least 80%. This is not a hypothesis test. Phase 3 (reperfusion) is not part of this measure.
Percentage of Subjects With Successful Bilateral Carotid Signal Acquisition During Reperfusion
Usable, continuous bilateral signal acquired for Phase 3, from before internal carotid artery clamp release through 1 to 2 minutes of restored flow. Reported descriptively and separately from the primary outcome, because both transducers are removed during the endarterectomy and re-application depends on not delaying the surgical team.
Carotid Flow Signal Characteristics Time-Locked to Internal Carotid Artery Clamp Application and Release
Signal characteristics, including flow velocity, wave-intensity and bilateral-asymmetry measures, described per subject relative to the documented clamp application and release time stamps, and summarized descriptively. All enrolled subjects with any recorded data are included; no imputation is performed and missing phases are reported as missing.
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