Carotid Artery Back Pressure

Moore, Wesley S.; Hall, Albert D.

doi:10.1001/archsurg.1969.01340180026005

Cited by 171 publications

(27 citation statements)

References 4 publications

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“…Although SP is commonly used, 14 EEG has been used extensively in some centers over the past decade. 1516 More recently, initial evaluations of the use of TCD in continuous intraoperative cerebral monitoring have been promising.…”

Section: Discussionmentioning

confidence: 99%

Importance of cerebral collateral pathways during carotid endarterectomy.

Schneider

Ringelstein

Rossman

et al. 1988

Stroke

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Before surgery, we evaluated major intracranial collateral pathways using transcranial Doppler ultrasonography (TCD) in 50 patients who then underwent carotid endarterectomy with concurrent multimodality cerebral monitoring. Patients were grouped with respect to collateral pathways demonstrated preoperatively by TCD: Group 1, good collateralization with an anterior and/or a posterior communicating artery ipsilateral to the operative carotid lesion (29 patients, 58%); Group 2, collateral pathways present but impeded by other proximal stenoses (nine patients, 18%); and Group 3, no collateralization identified (nine patients, 18%). Three patients (6%) could not be classified. TCD identified major collateral pathways with a sensitivity of 89% and a specificity of 80% when compared with arteriography. During carotid endarterectomy mean middle cerebral artery velocity, pulsatility index, and stump pressure were higher and the decrease in middle cerebral artery velocity with extracranial carotid artery cross clamping was significantly less among Group 1 patients than among Group 2 and 3 patients (p<0.Q5 for both groups). Group 1 patients required fewer intraoperative carotid artery shunts and developed fewer ischemic electroencephalographic abnormalities than did patients in Groups 2 and 3 (p<0.05 for both groups). TCD assessment of cerebral collateralization helps predict hemodynamic consequences of cross clamping during carotid endarterectomy. (Stroke 1988;19:1328-1334) C erebrovascular collateral blood supply plays an essential role in cerebral perfusion. In patients undergoing carotid endarterectomy the correlation of preoperative assessment of collateral potential with cerebral perfusion during extracranial carotid artery cross clamping enhances our understanding of intracerebral hemodynamics.Transcranial Doppler ultrasonography (TCD) can directly insonate the intracranial arteries to evaluate collateral perfusion around the circle of Willis. '-3 In addition, TCD provides continuous noninvasive monitoring of middle cerebral artery (MCA) blood velocity (MCAV) and immediately detects changes in cerebral perfusion during carotid artery manipulation and cross clamping.4 -6 The purposes of our study were to correlate prospectively the

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Section: Discussionmentioning

confidence: 99%

Importance of cerebral collateral pathways during carotid endarterectomy.

Schneider

Ringelstein

Rossman

et al. 1988

Stroke

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“…The optimal method for evaluating cerebral perfusion during CEA and determining the need for selective shunting is also controversial. Several investigators prefer carotid stump pressure measurements, 10,16,17 whereas others prefer transcranial Doppler 22,23 or electroencephalography (EEG) monitoring. 22,24,25 There are several arguments against the use of shunts, including unnecessary use in approximately 85% of patients and its associated morbidity, which may include atheromatous or air emboli, arterial dissection, and acute arterial occlusion.…”

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confidence: 99%

“…4,5,[26][27][28] Others who support the use of shunting cite its value in maintaining cerebral blood flow, thus allowing unhurried CEA. 10,11,16,17,[19][20][21] Some surgeons also believe that shunting aids in closure of the carotid arteries, whereas others believe the presence of shunt makes closure more difficult. 7,10,29 It has also been suggested that for those surgeons who use shunts only selectively, the relative infrequent use of the shunt makes its use more hazardous than with experienced surgeons.…”

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confidence: 99%

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Prospective randomized trial of routine versus selective shunting in carotid endarterectomy based on stump pressure

AbuRahma

Stone

Hass

et al. 2010

Journal of Vascular Surgery

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“…The most common systems to detect cere bral ischemia are: monitoring of neurological functions by using regional anesthesia [4,5], measurements of stump pressure [6], inter mittent regional cerebral blood flow [7], jugu lar venous oxygen saturation [8,9] and con tinuous EEG monitoring [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Continuous Intraoperative Electroencephalographic Monitoring in Carotid Endarterectomy

Mola¹,

Collice²,

Levati³

1986

Eur Neurol

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Continuous electroencephalographic (EEG) monitoring was done during 143 consecutive carotid endarterectomies in 130 patients to detect intolerance to cross-clamping. An intraluminal shunt was inserted when EEG changes appeared (in the first 100 procedures) or when EEG changes appeared and a long clamping time was supposed (in the last 43 cases). 121 patients had no EEG changes at clamping time and only 1 had a postoperative deficit due to embolization, which occurred before clamping and was revealed by a decrease of voltage on tracing. 15 patients showed early (within 4 min after clamping) changes and in 11 patients shunting led to the reversal of EEG anomalies in all cases but 2. The state of these 2 patients was worse after surgery, in one because of embolic problems, in the other (shunted 30 min after clamping) probably for hemodynamic reasons. 4 patients with early EEG changes, not shunted because of the short clamping time, had no neurological deficit. 7 patients, 2 of which were shunted, showed late (after 4 min) EEG changes. Only 1 nonshunted patient in this group awoke with a minor, transitory neurological complication. Moreover, EEG changes have been correlated with the preoperative clinical condition and with the presence, on angiography, of contralateral carotid lesions. Also, EEG findings have been correlated with the computed tomography data (in 71 cases) and with the values of interior carotid artery (ICA) back pressure (in 58 cases). No possibility to predict the tolerance to clamping appeared from these correlations. However, a relatively higher risk of intolerance to clamping in patients with contralateral ICA occlusion was noted. The authors confirm the validity of continuous EEG monitoring during carotid surgery to detect intolerance to cross-clamping and to reduce the complications of this operation.

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Carotid Artery Back Pressure

Cited by 171 publications

References 4 publications

Importance of cerebral collateral pathways during carotid endarterectomy.

Importance of cerebral collateral pathways during carotid endarterectomy.

Prospective randomized trial of routine versus selective shunting in carotid endarterectomy based on stump pressure

Continuous Intraoperative Electroencephalographic Monitoring in Carotid Endarterectomy

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