Non-Invasive Cerebral Autoregulation Monitoring During Awake Carotid Endarterectomy Identifies Clinically Significant Brain Ischaemia

Regional disparity in continuously measured time-domain cerebrovascular reactivity indices: a scoping review of human literature

“…PRISMA, preferred reporting items for systematic reviews and meta-analysis Appendix D gives a general overview of all 22 human studies with primary and secondary outcomes of the study and its limitations (Piechnik et al 1999, Lang et al 2003, Schmidt et al 2003a, 2003b, Soehle et al 2004, Yam et al 2005, Lavinio et al 2007, Joshi et al 2010, Reinhard et al 2003, 2004, 2008, Diedler et al 2011, Haubrich et al 2011, Budohoski et al 2015, Hori et al 2015, Bindra et al 2016, Adatia et al 2020, Meyer et al 2020, Zipfel et al 2020. Table 1 shows various CVR metrics assessed for each of the 8 disease categories: Healthy Volunteer (Piechnik et al 1999, Schmidt et al 2003b, Yam et al 2005, Reinhard et al 2008, Cardiac Surgery (Joshi et al 2010, Hori et al 2015, Endarterectomy (Reinhard et al 2003, 2004, Zipfel et al 2020, Intracerebral Hemorrhage (ICH) (Reinhard et al 2010), Subarachnoid Hemorrhage (SAH) (Soehle et al 2004, Budohoski et al 2015, Stroke (Reinhard et al 2005, Meyer et al 2020, TBI (Lang et al 2003, Schmidt et al 2003a, Lavinio et al 2007, Diedler et al 2011, Haubrich et al 2011, and Multiple...…”

“…Tables 2, 3, 4, 5, 6, 7, 8, and 9 describe eight categories of diseases. To measure surrogate for pulsatile CBF/CBv, 5 studies used NIRS (Diedler et al 2011, Hori et al 2015, Bindra et al 2016, Adatia et al 2020, Zipfel et al 2020, and 18 studies used TCD (Piechnik et al 1999, Lang et al 2003, Schmidt et al 2003a, 2003b, Soehle et al 2004, Yam et al 2005, Lavinio et al 2007, Joshi et al 2010, Reinhard et al 2003, 2004, 2008, Haubrich et al 2011, Budohoski et al 2015, Hori et al 2015, Meyer et al 2020 where one study used both (Hori et al 2015). All eligible studies reported on the association between measures of continuous CVR amongst more than one brain region or channel using the same CVR index.…”

“…All eligible studies reported on the association between measures of continuous CVR amongst more than one brain region or channel using the same CVR index. CVR indices measured in the studies included: 1 study measured cerebral flow velocity index with ABP (CFVx-a-correlation between ultrasound-tagged NIRS (UT-NIRS) data and MAP) (Hori et al 2015), 3 measured cerebral oximetry index with ABP (COx-a-correlation between rSO 2 and ABP) (Bindra et al 2016, Adatia et al 2020, Zipfel et al 2020, 3 measured diastolic flow index with ABP (Dx-a-correlation between diastolic flow velocity (FV d ) and ABP) (Reinhard et al 2003(Reinhard et al , 2004(Reinhard et al , 2008, 1 measured hemoglobin volume index with ABP (HVx-a-correlation between relative tissue hemoglobin concentration (rTHb) and ABP) (Zipfel et al 2020), 3 measured mean flow index (Mx-correlation between mean flow velocity (FV m ) and CPP) (Czosnyka et al 2003, Schmidt et al 2003a, Lavinio et al 2007, 16 measured Mx with ABP (Mx-a-correlation between FV m and ABP) (Piechnik et al 1999, Lang et al 2003, Schmidt et al 2003b, Soehle et al 2004, Yam et al 2005, Lavinio et al 2007, Joshi et al 2010, Reinhard et al 2003, 2004, 2008, Haubrich et al 2011, Hori et al 2015, Meyer et al 2020, 4 measured systolic flow index with ABP (Sx-a-correlation between FV s and ABP) (Piechnik et al 1999, Reinhard et al 2003, Soehle et al 2004, Budohoski et al 2015, and 1 measured total hemoglobin index with ABP (THx-a-correlation between tissue hemoglobin index (THI) and ABP) (Diedler et al 2011). There were 4 studies with healthy volunteers (Piechnik et al 1999, Schmidt et al 2003b, Yam et al 2005…”

Carotid Endarterectomy With Regional Anesthesia in Our Experience

“…On the contrary, the need for shunt and cerebral monitoring in GEA are disadvantages of this technique in CEA operations. The arguments that reasonable ventilation control, which can be considered an advantage, provides a safe airway, increase surgical comfort, and offer better cerebral protection are still debated (8). A comprehensive meta-analysis highlights that the risk of stroke, TIA, cardiac, pulmonary, and vascular complications, and 30-day mortality are higher in general anesthesia than in RA (9).…”

“…Electroencephalography (EEG) recordings showed that cerebral perfusion decreased by more than 70% in contralateral occlusions and carotid stenosis, and shunt use was recommended in these cases (10). In CEA surgeries performed under RA, being awake is the best method of monitoring the adequacy of brain perfusion (8). Therefore, RA is a technique that reduces unnecessary shunt use in CEA operations.…”