Prediction of Cerebral Ischemic Tolerance During Carotid Cross-clamping by Angiographic Criteria

Aleksic, M.; Gawenda, M.; Heckenkamp, J.; Matoussevitch, Vladimir; Coburger, Silke; Brunkwall, Jan

doi:10.1016/j.ejvs.2004.02.005

Cited by 11 publications

(7 citation statements)

References 23 publications

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“…These patients have a seven-fold greater tendency to require shunt insertion in patients under regional anaesthesia. Impaired ischaemic tolerance after previous strokes has already been observed [7, 12–14]. In the present study there was also a higher shunt frequency in patients who had suffered a prior stroke (83.3% vs. 76.6%), but this difference did not reach statistical significance, probably due to the small sample size.…”

Section: Discussioncontrasting

confidence: 69%

Interaction of cerebrovascular disease and contralateral carotid occlusion in prediction of shunt insertion during carotid endarterectomy

Estruch-Pérez¹,

Plaza-Martínez²,

Hernández-Cádiz³

et al. 2012

aoms

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IntroductionTo assess the possible role and the interaction of cerebrovascular disease and vascular stenosis on the necessity of shunt insertion during carotid endarterectomy (CEA).Material and methodsEighty consecutive patients undergoing CEA under regional anaesthesia were prospectively enrolled. Patients were divided into two groups depending on whether they were shunted or not. The measured end-points were co-morbidities degree of contralateral and carotid stenosis and other intra- and postoperative outstanding parameters. ANOVA, Student's t and χ2 tests were used (p<0.05). Variables differing significantly between groups and potential confounders were used in backward stepwise logistic regression to estimate the relative risk (RR, 95% CI) of shunt. In addition Wald's test (p<0.05) with and without adjustments for potential confounders was used with various different multivariate analysis models.ResultsContralateral stenosis and cerebral vascular accidents (CVA) were more frequently observed in shunted patients. The RR for patients with contralateral stenosis ≥ 50% was 1.3 (95% CI 1.0-1.5) and for patients with previous CVA was 1.2 (95% CI 1.0-1.4). For contralateral stenosis and CVA together the RR increased to 7.7 (95% CI 1.0-14.4). A model based on contralateral stenosis and CVA was found to be statistically significant (p=0.003) for shunt (RR=1.1, 95% CI 1.0-2.1). Relative excess risk due to interaction of both factors was 6.2.ConclusionsThe findings suggest that patients with contralateral stenosis ≥ 50% and previous CVA have a higher risk of requiring shunt use during CEA than patients with these risk factors separately.

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Section: Discussioncontrasting

confidence: 69%

Interaction of cerebrovascular disease and contralateral carotid occlusion in prediction of shunt insertion during carotid endarterectomy

Estruch-Pérez¹,

Plaza-Martínez²,

Hernández-Cádiz³

et al. 2012

aoms

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“…A number of preoperative testing strategies to predict risk of cerebral ischemia and shunt placement have been identified. Some, such status of the Circle of Willis, bilateral vertebral artery stenosis, and other angiographic factors, 36–38 , are not routinely collected preoperative data-points. There is no evidence that increased testing to identify these risk factors is cost-effective or changes outcomes 36 .…”

Section: Discussionmentioning

confidence: 99%

Predictors of cross-clamp-induced intraoperative monitoring changes during carotid endarterectomy using both electroencephalography and somatosensory evoked potentials

Sridharan

Thirumala

Chaer

et al. 2018

Journal of Vascular Surgery

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Whereas some patients can be expected to experience IOM changes by monitoring of SSEPs and EEG, a much smaller percentage will receive a shunt. Contralateral carotid occlusion, symptomatic stenosis, diabetes, and female sex increase the risk of clamp-induced IOM changes and should be anticipated to need a shunt. Patients receiving beta blockers are likely to experience IOM changes during the operation that are not associated with clamping.

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“…Aleksic et al [16 ] designed a prospective trial of 120 patients who underwent cerebral angiography prior to carotid surgery (under local anesthesia) with the aim of determining whether lack of collateral flow from the contralateral hemisphere is a predictor for shunt placement. Before cross-clamping the carotid artery, stumppressure was measured.…”

Section: Monitoringmentioning

confidence: 99%

Review of developments in anesthesia for carotid endarterectomy

Erickson

Cole

2005

Current Opinion in Anaesthesiology

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Prediction of Cerebral Ischemic Tolerance During Carotid Cross-clamping by Angiographic Criteria

Abstract: Angiographic cross-flow was a good, but not perfect predictor for the need of an intraoperative shunt.

Cited by 11 publications

References 23 publications

Interaction of cerebrovascular disease and contralateral carotid occlusion in prediction of shunt insertion during carotid endarterectomy

Interaction of cerebrovascular disease and contralateral carotid occlusion in prediction of shunt insertion during carotid endarterectomy

Predictors of cross-clamp-induced intraoperative monitoring changes during carotid endarterectomy using both electroencephalography and somatosensory evoked potentials

Review of developments in anesthesia for carotid endarterectomy

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