Evaluation of Shunt Use with Near Infrared Spectroscopy During Carotid Endarterectomy: An Observational Clinical Study

Abstract

A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Measurement of cerebral saturation (NIRS) with is that noninvasive method can early and easily demonstrate disorders in cerebral blood flow without the need for specialized personnel. In this study, we evaluated not only the relationship between cerebral monitoring values and shunt use but also postoperative short term effect of cerebral monitoring in patients undergoing carotid endarterectomy. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Between 2010 and 2015, 427 patients underwent 481 carotid endarterectomy operations. Sixty-five of these patients (13.5%) had bilateral critical carotid stenosis. Carotid endarterectomy was performed under shunt requirement in 54 cases (11.2%). The NIRS probe was placed in the frontal region of the patient to monitor the cerebral oxygen level of the patients. At this time, NIRS values of patients were recorded before cross-clamp (rSO 0), cross-clamp (rSO1) and post-clamp (rSO2). Following operation, the patients were transfered to intensive care unit and then to the ward after staying 2-4 hours. Operational time, cross-clamp time, complications within 30 days associated with operation were recorded. Subsequent checks were made by the neurologist on the 30th day and every 6 months on follow-up. R Re es su ul lt ts s: : The mean age was 69.95±12.84 in group 1 and 66.18±7.11 years in group 2. There was a significant difference in the carotid clamping time (min), percentage of carotid angioplasty, bilateral carotid procedures between group 1 and group 2 (23.85±12.4 vs 15.18±7.11, 100% vs 79.2%, 74.07 vs 5.85, p<0.01, respectively). The length of intensive care unit and hospital stays were similar among groups. regional cerebral oxygen saturation in first 3 min after carotid artery clamping (rSO1) in shunt group was lower compared to the patients in no-shunt group (48.7±11.5 vs 59.7±6.77, p=0.03) C Co on nc cl lu us si io on ns s: : As a result, NIRS is a safely and a reliable cerebral monitoring technique and also it may help to reduce unnecessary shunt use in patients undergoing carotid endarterectomy. K Ke ey yw wo or rd ds s: : Endarterectomy, carotid; spectroscopy, near-infrared Ö ÖZ ZE ET T A Am ma aç ç: : Near infrared spectroscopy (NIRS) ile serebral oksijen saturasyonu ölçümü, serebral kan akımının noninvaziv bir ölçümüdür. Bu çalışmada sadece karotis endarterektomi uygulanan hastalarda serebral monitörizasyon değerleri ile şant kullanımı arasındaki ilişkiyi değil, aynı zamanda postoperatif serebral monitörizasyon etkisini de değerlendirdik. G Ge er re eç ç v ve e Y Yö ön n--t te em ml le er r: : 2010 ile 2015 yılları arasında 427 hasta 481 karotis endarterektomi ameliyatı geçirdi. Bu hastalardan 65'inde (%13,5) bilateral kritik karotis stenozu vardı. 54 hastada (%11,2), karotis endarterektomi şant gereksinimi altında uygulandı. Near infrared spectroscopy ile, hastanın serebral oksijen seviyesini izlemek için frontal bölgeye elektrodlar yerleştirildi. Bu sırada, hastaların kross klemp öncesi (rSO 0), kro...