Cerebral Neuromonitoring during Carotid Endarterectomy and Impact of Contralateral Internal Carotid Occlusion

Autor: Milan Milošević, Davorin Sef, Vinko Vidjak, Anita Škrtić, Andrija Škopljanac-Mačina
Rok vydání: 2018
Předmět:
Male
medicine.medical_specialty
Time Factors
Intraoperative Neurophysiological Monitoring
medicine.medical_treatment
Collateral Circulation
Carotid endarterectomy
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Risk Factors
medicine.artery
Internal medicine
Occlusion
medicine
Humans
Arterial Pressure
Carotid Stenosis
Local anesthesia
Prospective Studies
Cerebral perfusion pressure
Stroke
Aged
Endarterectomy
Carotid
business.industry
carotid artery stenosis
stroke
stump pressure
Rehabilitation
Blood Pressure Determination
Perioperative
Middle Aged
medicine.disease
Shunting
Treatment Outcome
Cerebrovascular Circulation
Cardiology
Female
Surgery
Neurology (clinical)
Internal carotid artery
Cardiology and Cardiovascular Medicine
business
Carotid Artery
Internal
030217 neurology & neurosurgery
Zdroj: Journal of Stroke and Cerebrovascular Diseases. 27:1395-1402
ISSN: 1052-3057
DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.030
Popis: Background: The aim of this study was to identify the reliability of carotid artery stump pressure (SP) in predicting the neurologic changes and correlation with contralateral internal carotid artery (ICA) occlusion in patients undergoing eversion carotid endarterectomy (CEA). The optimal method for monitoring cerebral perfusion during CEA, performed under either local or general anesthesia, is still controversial. Methods: We prospectively analyzed 118 consecutive patients undergoing eversion CEA under local anesthesia. We had 78 symptomatic (66%) and 40 asymptomatic patients (33.9%). Selective shunting was performed in patients who developed neurologic changes after carotid clamping regardless of SP. Correlation of preoperative symptom status, a degree of stenosis, status of contralateral ICA, arterial blood pressure, SP value, and the intraoperative need for shunting due to neurologic changes was evaluated for both groups: shunted and nonshunted. Results: Selective shunting was performed in 12 patients (10%). There was no significant difference among the groups regarding the demographic characteristics. Mean carotid clamping time was 14.57 minutes. We had no perioperative mortality, stroke, or myocardial infarction. None of the patients required conversion to general anesthesia. We found a mean SP of 31 mm Hg as a reliable threshold for shunting (P < .001 ; sensitivity 92.3% ; specificity 91.3%). Contralateral carotid occlusion was correlated with the significantly lower SP (27 ± 13 mm Hg ; P = .001) and the higher need for shunt (50%). Conclusions: SP measurement is a reliable and simple method for monitoring the collateral cerebral perfusion and can predict the need for shunting during CEA. Patients with the contralateral ICA occlusion showed significantly lower SP, although it did not have impact on the outcome.
Databáze: OpenAIRE
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