Optimal cerebral monitoring during carotid endarterectomy: Neurologic response under local anesthesia

Evans, William E.; Hayes, James; Waltke, Eugene A.; Vermilion, Blair D.

doi:10.1016/0741-5214(85)90121-1

Cited by 98 publications

(29 citation statements)

References 12 publications

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“…12 -2 '- 27 Cerebral blood flow may be compromised after carotid cross-clamping or as the result of hypotension, whereas perioperative embolization can be regarded as mainly a surgical problem. 7 Postoperative occlusion of the internal carotid artery may be asymptomatic or may result in either a hemodynamic or a thromboembolic infarct.…”

Section: Discussionmentioning

confidence: 99%

Site and pathogenesis of infarcts associated with carotid endarterectomy.

Krul¹,

Gijn²,

Ackerstaff³

et al. 1989

Stroke

126

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We analyzed perioperative strokes in 658 carotid endarterectomies with the purpose of explaining the pathogenesis from the morphologic aspect of the infarct on cerebral computed tomograms. All endarterectomies were performed with continuous electroencephalographic monitoring. Of the 42 ischemic strokes (6.4% of all endarterectomies), 34 could be studied. Seven infarcts were hemodynamically induced (five watershed infarcts, two patients with bilateral ischemia); all seven occurred during surgery. Twenty-three of the remaining 27 infarcts were within the territory of the middle cerebral artery (20) or anterior cerebral artery (three) and were probably of thromboembolic origin; 13 of these 23 occurred during surgery (57%). If intraoperative stroke was heralded by permanent electroencephalographic changes, these were not related to the moment of cross-clamping. In four patients the computed tomogram was normal. We believe these facts favor the hypothesis that thromboembolism is the most important factor in the pathogenesis of perioperative stroke associated with carotid endarterectomy under conditions of optimal cerebral monitoring. (Stroke 1989;20:324-328)

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Section: Discussionmentioning

confidence: 99%

Site and pathogenesis of infarcts associated with carotid endarterectomy.

Krul¹,

Gijn²,

Ackerstaff³

et al. 1989

Stroke

126

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“…Carotid stump pressure is considered the criterion for safe ligation of the carotid artery 3 . However, even with that criterion, there is occasional failure to identify patients at risk of developing postoperative neurologic deficits 4,5 . These preoperative examinations may estimate the risk of neurologic sequelae, but they are not yet highly accurate.…”

Section: Discussionmentioning

confidence: 99%

Carotid Resection and Reconstruction for Advanced Cervical Cancer

Katsuno¹,

Ishiyama²,

Sakaguchi³

et al. 1997

The Laryngoscope

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Patients with advanced cervical cancers often have direct invasion of their carotid arteries. The prognosis for these patients with nonsurgical therapy is extremely poor. Because complete tumor removal is the only therapy that can offer these patients a chance for cure, carotid resection should be performed. We performed carotid resection and reconstruction on nine patients with advanced cervical cancers. Of these patients, none suffered from severe neurologic postoperative complications such as permanent hemiplegia. Three of the nine patients have been disease free for more than 24 months. These three patients would not have survived without carotid resection. Further study will show the usefulness of carotid resection and reconstruction in decreasing the morbidity and mortality in patients with cervical cancer involving the carotid artery.

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“…Studies have proved that development of stroke during CEA under local anesthesia is an indication of shunt insertion to meet with cerebral perfusion. 21) We also used shunt in another three patients with more than 90% carotid stenosis on both sides. Shunt was dislodged in one such patient.…”

Section: Discussionmentioning

confidence: 99%

Advantages of Selective Use of Intraluminal Shunt in Carotid Endarterectomy: a Study of 122 Cases

Jamil

Rashid

Ghaffar

2016

Annals of Vascular Diseases

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Objectives:To assess the advantage of selective use of shunt in carotid endarterectomy (CEA) under local anesthesia. Materials and Methods: A total of 122 consecutive patients fulfilling international guidelines were included. Shunt was used selectively only in cases of bilateral severe carotid artery occlusive disease or in those patients who developed neurological symptoms on clamping of carotid artery. Follow up was done weekly for one month; then every month for 3 months; and then every 3 months for a year. Results: Shunt was used only in 5% (n = 6) patients. Of these, 2.5% (n = 3) patients were those who developed neurological symptoms on clamping the internal carotid and deployment of shunt resulted in complete resolution of symptoms. 2.5% (n = 3) had severe bilateral carotid stenosis and shunt was deployed. One of these patients developed stroke which was permanent. There was no mortality. The mean procedure time was 170 min in patients in whom shunt was used, when compared with 100 min in patients without shunt (P = 0.003). Conclusion: Use of shunt in carotid endarterectomy under local anesthesia as selective policy has an advantage in terms of cost effectiveness, operation time and prevention of potential complications.Keywords: shunt, carotid artery, surgery, local anesthesia, advantage in asymptomatic disease and higher in symptomatic patients. 1) The major risk factors are advanced age, male gender, smoking and diabetes mellitis. 2,3) To make stroke free survival carotid endarterectomy (CEA) is performed in asymptomatic and symptomatic patients with ≥70% and ≥50% stenosis of internal carotid artery respectively. 4,5) Perioperative strokes mostly are due to ipsilateral diseased carotid but some may be due to carotid artery clamping resulting in brain ischemia. 4) The duration of interrupted blood flow can be reduced by using a shunt to fulfill circulatory needs of the brain. CEA can be performed under local or general anesthesia with routine or selective use of shunt. 4,5) Potential disadvantage of using shunt during CEA include increase in operation time, dislodgement, bleeding, dissection of artery, tear in the artery wall, air or plaque embolism and increased local complications like nerve injury, infection, hematoma and long term stenosis. 6) However, reliable data is limited. 7) Selective use of shunt in cases of bilateral severe carotid artery occlusive disease and in those cases which developed neurological symptoms on clamping of carotid artery, can reduce shunt induced complications. 7) Keeping in view these international reviews and scarcity of guidelines in our national literature, we performed this study in our department with selective use of shunt to assess shunt related perioperative morbidity. Materials and MethodsAll consecutive patients reporting to the department of Vascular Surgery in Combined Military Hospital Lahore between January 2012 to January 2015; with documented narrowing of carotid artery occlusive disease, were included in this study. Of these, patients who were symptoma...

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Optimal cerebral monitoring during carotid endarterectomy: Neurologic response under local anesthesia

Cited by 98 publications

References 12 publications

Site and pathogenesis of infarcts associated with carotid endarterectomy.

Site and pathogenesis of infarcts associated with carotid endarterectomy.

Carotid Resection and Reconstruction for Advanced Cervical Cancer

Advantages of Selective Use of Intraluminal Shunt in Carotid Endarterectomy: a Study of 122 Cases

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