Internal Carotid Artery Stump Pressure and Cerebral Blood Flow During Carotid Endarterectomy

McKay, Robert D.; Sundt, Thoralf M.; Michenfelder, John D.; Grondert, G. A.; Messick, Joseph M.; Sharbrough, Frank W.; Piepgras, David G.

doi:10.1097/00132586-197710000-00028

Cited by 15 publications

(18 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…23 Additional factors must be involved, however, as Halothane lowers CMRO 2 but fails to reduce infarction from MCA occlusion. 30 ' 31 Moreover, agents acting as vasoconstrictors (narcotics 32 ) or as weak vasodilators (Isoflurane) were associated with a lower incidence of EEG change during internal carotid artery clamping in this study than cerebral vasodilators (Enflurane and especially Halothane. 29 ) Although Halothane and Enflurane increase CBF, this effect may "steal" blood from less vaso-responsive ischemic areas and thereby lower CBF in such regions.…”

mentioning

confidence: 47%

Significance of EEG changes at carotid endarterectomy.

Blume¹,

Ferguson²,

McNeill³

1986

Stroke

130

View full text Add to dashboard Cite

SUMMARY Visually apparent EEG changes associated with damping the internal carotid artery appeared in 55 of 176 consecutive patients (31%) undergoing carotid endarterectomy without shunt. Attenuation of higher frequency activity was the most common change. Changes were moderate in 33 patients (19%) and major hi 22 (12.5%). Major changes usually commenced earlier than less severe alterations. EEG changes resolved within 10 minutes of clamp release in 36 of 55 patients (65%) after an average clamp time of 36.25 minutes.Changes occurred more commonly when pre-operative EEGs were abnormal contralateral to clamping and when the contralateral carotid artery was more than 90% stenosed.Of the inhalational anesthetics employed with nitrous oxide and oxygen, isoflurane was associated with the lowest incidence of damp-associated EEG change.Post-operative strokes occurred in 2 of 22 patients (9%) with major damp-associated EEG changes, none of 33 patients with moderate changes and none of 121 without changes. However, the mechanism of this relationship remains in doubt.

show abstract

mentioning

confidence: 47%

Significance of EEG changes at carotid endarterectomy.

Blume¹,

Ferguson²,

McNeill³

1986

Stroke

130

View full text Add to dashboard Cite

show abstract

“…This conclusion is in agreement with other investigations. 29 ' 31 The rCBF has been poorly correlated with stump pressure in previous studies (r=0.62, 4 r=0.51, 6 and r=0.53 31 ). The difference in those correlations may be due to technical problems with rCBF measurements or problems with pressure zero references.…”

mentioning

confidence: 75%

“…At cross-clamping, the rCBF/vMCA relation intercepted the rCBF axis between 5 and 10 ml/100 g/min, indicating some cortical perfusion when vMCA is zero. Also, the rCBF/stump pressure relation 6 intersects the pressure axis between 9 and 16 mm Hg. It appears from these studies and the present study that both cerebral perfusion and MCA velocity cease at some positive arterial pressure between 8 and 20 mm Hg and that MCA velocity may reach zero before cortical perfusion ceases.…”

mentioning

confidence: 97%

Relation between middle cerebral artery blood flow velocity and stump pressure during carotid endarterectomy.

Spencer¹,

Thomas²,

Moehring³

1992

Stroke

View full text Add to dashboard Cite

Background and Purpose: Many patient monitoring techniques have been used for detecting cerebral hypoperfusion during carotid endarterectomy. We compared middle cerebral artery blood flow velocities with carotid artery stump pressures to evaluate the indications for common carotid artery cross-clamp shunting and the probable hemodynamic causes of cerebrovascular complications.Methods: Blood flow velocities were monitored with transcranial Doppler ultrasound and carotid stump pressures were measured at the time of common carotid artery cross-clamping during 97 carotid endarterectomy procedures. Stump pressures measured with the gauge zero reference at the common carotid artery level were correlated with the percentage change of velocities.Results: Middle cerebral artery blood flow velocities usually decreased upon common carotid artery cross-clamping, depending on collateral availability and the autoregulation response. The best fit of the data was to an exponential function concave to the pressure axis, with velocity as a percentage of the pre-cross-clamp value reaching zero at 15 mm Hg stump pressure (r=0.85 andp<0.001).Conclusions: There is a less critical margin of error with percentage middle cerebral artery blood flow velocity decreases than with stump pressure measurements. This relation establishes changes in middle cerebral artery blood flow velocities as a reliable parameter for judging the effects of carotid crossclamping on cerebral blood flow and providing an excellent indicator as to the necessity for shunting.

show abstract

“…It is also important to realise that the anaesthetist, by his choice of anaesthetic technique may influence the stump pressure. This was demonstrated years ago by McKay et al 29 Stump pressures were generally higher when fixed agent anaesthesia (Innovar) was employed compared to anaesthesia with volatile agents. Importantly, in their study, ipsilateral hemispheric blood flow was higher with halothane at lower stump pressures.…”

Section: ) Monitoring Of Stump Pressurementioning

confidence: 84%

“…II est aussi important de r&liser que l'anesth6siste en choisissant un agent plut6t qu'un autre peut influencer la pression du moignon. Ceci a 6t6 d6montr6 il y a des ann&s par McKay et al 29 La pression du moignon &ait g6n6ralement plus 61ev6e quand un agent intraveineux (Innovar) &air utilis6 ~ la place d'un agent volatil. Dans cette 6tude, il est ~ noter que le d6bit sanguin h6misph6rique homolat6ral sous halothane &ait plus 61ev6 malgr6 les basses pressions enregistr&s au niveau du moignon.…”

Section: ) Le Monitorage De La Pression Du Moignonunclassified

Anaesthesia for carotid artery surgery

Mutch

1997

Can J Anaesth

View full text Add to dashboard Cite

Internal Carotid Artery Stump Pressure and Cerebral Blood Flow During Carotid Endarterectomy

Cited by 15 publications

References 0 publications

Significance of EEG changes at carotid endarterectomy.

Significance of EEG changes at carotid endarterectomy.

Relation between middle cerebral artery blood flow velocity and stump pressure during carotid endarterectomy.

Anaesthesia for carotid artery surgery

Contact Info

Product

Resources

About