Near-infrared spectroscopy as a predictor of cerebral ischaemia during carotid endarterectomy in awake patients
| Autor: | Donatas Inčiūra, Aleksandras Antuševas, Linas Velička, Agnė Gimžauskaitė, Žana Kavaliauskienė, Adomas Aladaitis |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Carotid endarterectomy 030204 cardiovascular system & hematology Risk Assessment Brain Ischemia 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Risk Factors Monitoring Intraoperative Internal medicine medicine Humans Carotid Stenosis Radiology Nuclear Medicine and imaging Prospective Studies 030212 general & internal medicine Aged Endarterectomy Carotid Spectroscopy Near-Infrared business.industry Near-infrared spectroscopy Blood Pressure Determination Monitoring system General Medicine Middle Aged Oxygen Stump pressure Shunting Treatment Outcome Cardiology Female Surgery Cerebral ischaemia Cardiology and Cardiovascular Medicine business Biomarkers Carotid Artery Internal |
| Zdroj: | Vascular. 28:301-308 |
| ISSN: | 1708-539X 1708-5381 |
| DOI: | 10.1177/1708538119893830 |
| Popis: | Objectives The aim of our study was to evaluate the near-infrared spectroscopy monitoring system to detect cerebral ischaemia, find indications for selective shunting during carotid endarterectomy and compare it with an internal carotid artery stump pressure monitoring technique in patients operated under local anaesthesia. Methods During January 2015 and November 2018, 131 patients undergoing carotid endarterectomy under local anaesthesia were prospectively included in the study. Near-infrared spectroscopy as intraoperative monitoring was applied and compared with stump pressure. Results Carotid endarterectomy was performed successfully in 106 patients operated under local anaesthesia. Meanwhile, 25 patients developed neurological changes (motor or consciousness impairment, weakness of extremities, cognitive decline) during clamping, and all of them received a shunt. ΔrSO2, stump pressure and rSO2 (–11 ± 8%, 31 ± 6mmHg, 58 ± 11) values were smaller in the group of shunted subjects versus non-shunted group subjects (–2 ± 5%, 61 ± 17 mmHg, 64 ± 8) after 1 min of internal carotid artery clamping ( p 2 to predict ischaemia symptoms during carotid clamping. Using stump pressure with a cut-off value of ≤40 mmHg for predicting symptoms, the sensitivity was 82% and specificity 54%. Conclusions Near-infrared spectroscopy is a suitable non-invasive cerebral oxygenation monitoring method during carotid endarterectomy. A 10% decrease of ΔrSO2 had a good correlation with clinical cerebral ischaemia signs and matched well with the stump pressure cut-off value of ≤40 mmHg. There is a possibility of near-infrared spectroscopy to replace stump pressure in cerebral oxygenation monitoring during carotid endarterectomy. However, we need larger prospective multicentre studies to identify the optimal threshold for shunt requirement. |
| Databáze: | OpenAIRE |
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