Is Near-Infrared Spectroscopy a Reliable Method to Evaluate Clamping Ischemia during Carotid Surgery?

Pedrini, L; Magnoni, F.; Sensi, Luigi; Pisano, Emilio; Ballestrazzi, Maria Sandra; Cirelli, M; Pilato, Alessandro

doi:10.1155/2012/156975

Cited by 32 publications

(52 citation statements)

References 22 publications

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“…Use of intraluminal shunt and general anesthesia are routinely recommended in most studies, but unpleasant complications during placement of shunt into the internal carotid artery are well known. [20][21][22][23][24] Anesthesia is the one of the most controversial issues of carotid endarterectomy. Detailed studies have reported cervical blockage has better results concerning perioperative stroke and cardiac events, such as arrhythmia and infarction.…”

Section: Resultsmentioning

confidence: 99%

“…Intraluminal shunt use increased 20% to 25% in studies using EEG for cerebral monitoring, while 7% decrease was observed in patients who underwent carotid endarterectomy under regional anesthesia, which allows evaluation of consciousness and responses. [22,23] Furthermore, EEG cannot always detect perioperative cerebrovascular events. Regional anesthesia and awake patient provide precise information and evaluation, facilitating decision about shunt according to the case.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies have found better results in terms of perioperative neurological complications with regional anesthesia compared with general anesthesia. [22,23] Rate of use of intraluminal shunts in carotid endarterectomy was 10% to 15% in the literature. [24,25] We used shunts in 2 patients (9.5%) who had critical contralateral carotid artery stenosis.…”

Section: Resultsmentioning

confidence: 99%

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Awake Carotid Endarterectomy in Patients Undergoing Cardiac Surgery: Our 6 Years of Experience

Öz¹

2017

South Clin Ist Euras

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Objective: Optimal surgical approach for patients with hemodynamically significant carotid and cardiac disease remains controversial. Methods:Total of 370 randomized patients who underwent 412 carotid endarterectomies (42 cases were bilateral) and cardiac surgery between 2009 and 2014 were enrolled in the study. All patient data, including demographic details, risk factors, immediate perioperative events, 30-day and long-term outcome, were prospectively recorded and then analyzed statistically as mean and SD.Results: Of the patients, 29.4% (n=108) were female and 70.6% (n=262) were male. Mean age was 64 years (range: 42-86 years). In all, 37.03% (n=137) of the patients were defined as symptomatic. Asymptomatic severe carotid artery stenosis (≥70%) was diagnosed in 62.98% (n=233) of the patients. Mean observation time in intensive care unit following surgery was 2.84 (±1.20) hours and total hospital stay was 3.72 (±1.64) days. Restenosis was diagnosed in 7 (1.69%) of the patients during follow-up. Rate of cardiac events and stroke in postoperative early term were 2.94% and 0.72%, respectively. Conclusion:Awake carotid endarterectomy is safe and reliable procedure. Patient consciousness can be optimally evaluated during operation with regional anesthesia, thereby allowing for precise determination of need for shunt and avoiding unnecessary use.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Awake Carotid Endarterectomy in Patients Undergoing Cardiac Surgery: Our 6 Years of Experience

Öz¹

2017

South Clin Ist Euras

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“…Yet it has been criticized for the wide range of values in normal conditions and for the lack of a clear cut-off value. Furthermore, many confounding factors may influence regional brain saturation, such as modification of systemic oxygen saturation and blood pressure or bronchodilation (16).…”

Section: Discussionmentioning

confidence: 99%

Noninvasive cerebral oximetry during carotid endarterectomy: application and results

Kontrimavičiūtė¹,

Kuzminskaitė²,

Šipylaitė³

2015

AML

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Background. Cerebral monitoring during carotid endarterectomy allows to detect brain hypoperfusion following carotid clamping and hyperperfusion after restoring the blood flow. Immediate corrections of these changes have the potential in reducing adverse neurologic outcomes. In this study we share our experience using cerebral oximetry in carotid endarterectomy surgery, as well as finding a connection between comorbidities and baseline cerebral oxygenation values.Materials and methods. A non-randomised perspective study was performed at Vilnius University Hospital Santariškių Clinics. During 2012-2013 all consecutive elective patients undergoing carotid surgery were enrolled in the study.Results. No difference was found in the baseline values on the operative and control sides (71.15% vs 76.76%, p = 0.15). After carotid clamping regional brain saturation decreased by 4.34% of the baseline on the operative side. During the clamping cerebral oxygenation was lower on the operative side (68.06% vs 77.32%, p = 0.03). Following carotid declamping the difference between operative and control side oxygenation diminished (73.57% vs 79.30%, p = 0.16). Neither diabetes nor peripheral atherosclerosis had influence on baseline cerebral oxygen saturation values. There was a tendency towards the lower cerebral oxygenation baseline for smokers (70.12% vs 76.54%, p = 0.103).Conclusions. Cerebral oximetry is a valuable method of cerebral monitoring reflecting changes in brain perfusion during carotid endarterectomy. Certain comorbidities might have a role in affecting baseline oximetry values.

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“…It has also shown its correlation with EEG changes, transcranial Doppler, carotid stump pressure and postoperative neurological deficits [29,[30][31][32][33]. The sensitivity of this test ranges from 30 to 100% according to various studies and its specificity between 77 and 98% [29,[30][31][32][33][34][35][36].…”

Section: Near Infrared Spectroscopy (Nirs)mentioning

confidence: 94%

Carotid Stenosis and Anaesthesia

Jj¹,

A²,

Jl³

et al. 2016

Int J Surg Surgical Proced

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EpidemiologyThe importance of carotid stenosis approach lies in the relationship it has with ischemic stroke, since it is present in 10-20% of all of them. This is of magnitude when we know that in Western countries, stroke is the third leading cause of death, behind only heart disease and cancer, with a mortality ranging from 10 to 30%, having survivors risk of recurring ischemic cardiac or neurologic events, so much so that is the leading cause of disability. The prevalence of stenosis in the internal carotid artery (ICA) is high and furthermore increases with age, in fact more than 50% stenosis rises from 0.5% in people aged between 50 and 59 years to 10% in those over 80 years. The primary mechanism involved in stroke in patients with carotid stenosis is embolism of atherosclerotic or thrombotic waste material from the plate to the distal cerebral vasculature. Infiltration of inflammatory cells on the surface of carotid plaques can play a key role in causing plaque rupture and embolization or occlusion of the carotid and also hemodynamic factors are correlated with increased risk of stroke in patients with carotid stenosis [1,2,3]. Of all the factors studied, the degree of arterial stenosis has emerged as the most directly related to the increased risk of stroke. Any diagnostic strategy, whatever the technique used, should have as its primary objective to determine, in the most accurate way, the amount of this stenosis [4].In the NASCET study the risk of ipsilateral recurrent stroke in patients with symptomatic carotid stenosis treated conservatively was 4.4% per year for patients with stenosis between 50 and 69% and 13% per year for those with 70% stenosis. The risk in patients with asymptomatic stenosis of 60% was around 1-2%, but could rise to 3-4% per year in elderly patients or in the presence of stenosis or occlusion of the contralateral artery, evidence of silent embolization in an imaging test, heterogeneity of the carotid plaque, poor collateral circulation, generalized inflammatory state or peripheral or coronary artery disease associated [5]. Treatment Medical versus interventional treatmentGiven the above discussion, we will assume that the main objective in the treatment of carotid stenosis is the prevention of ischemic stroke and its aftermath, regardless of the type of patient, the presence or absence of symptoms and the degree of stenosis. However, despite the clarity of the target it is unclear what therapeutic option to choose among only medical treatment or revascularization and, in the latter case, between endoluminal or surgical treatment. We will be guided in this review [6], considering that these guidelines place more emphasis on stroke prevention in the prevention of ischemic heart disease, on the grounds that according to the CREST study, stroke has shown greater impact on quality of life of the patient than nonfatal myocardial ischemia [7].The major determinants of the clinical course are the presence or absence of neurological symptoms and the degree of stenosis. The threat of isc...

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Is Near-Infrared Spectroscopy a Reliable Method to Evaluate Clamping Ischemia during Carotid Surgery?

Cited by 32 publications

References 22 publications

Awake Carotid Endarterectomy in Patients Undergoing Cardiac Surgery: Our 6 Years of Experience

Awake Carotid Endarterectomy in Patients Undergoing Cardiac Surgery: Our 6 Years of Experience

Noninvasive cerebral oximetry during carotid endarterectomy: application and results

Carotid Stenosis and Anaesthesia

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