Subclinical Neurocognitive Dysfunction After Carotid Endarterectomy—The Impact of Shunting

Mazul-Sunko, Branka; Hromatko, Ivana; Tadinac, Meri; Sekulić, Ante; Ivanec, Željko; Gvozdenović, Aleksandra; Tomašević, Boris; Gavranović, Željka; Mladić-Batinica, Inga; Čima, Ana; Vrkić, Nada; Lovričević, Ivo

doi:10.1097/ana.0b013e3181d5e421

Cited by 25 publications

(11 citation statements)

References 26 publications

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“…However, the use of a shunt makes the operation technically more demanding and carries potential complications such as embolism or damage to arterial walls. Shunt insertion has also been related to postoperative internal carotid artery (ICA) re-stenosis after CEA [4] and to subclinical neurocognitive dysfunction [5], although the literature also shows controversy. In this context, it would be an advantage to preoperatively predict which patient will need a shunt.…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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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“…For the present review, 4,130 nonduplicate articles were screened and 31 articles were included in the analysis (Fig 1), 10-12,14-17,19-32,34,35,39-41 of which 6 were RCTs. 10,18,19,22,29,39 Study characteristics are summarized in Table 2. 10,12, Table 3 summarizes the preoperative characteristics of included patients.…”

Section: Resultsmentioning

confidence: 99%

General Anesthesia Versus Local Anesthesia in Carotid Endarterectomy: A Systematic Review and Meta-Analysis

Harky

Chan

Kot

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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“…Literature searches of the databases identified 1294 articles. Following the screening of retrieved titles or abstracts and after assessing the full texts of relevant reports, we selected 33 articles for analysis (Fig. ).…”

Section: Resultsmentioning

confidence: 99%

Meta‐analysis and trial sequential analysis of local vs. general anaesthesia for carotid endarterectomy

et al. 2018

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Controversy exists regarding the best choice of anaesthesia for carotid endarterectomy. We aimed to evaluate the peri-operative outcomes of local vs. general anaesthesia for carotid endarterectomy. We conducted a systematic search of electronic information sources and applied a combination of free text and controlled vocabulary searches adapted to thesaurus headings, search operators and limits in each of the electronic databases. We defined peri-operative stroke, transient ischaemic attack, mortality and myocardial infarction as the primary outcome measures. We identified 12 randomised controlled trials and 21 observational studies reporting a total of 58,212 patients undergoing carotid endarterectomy under local or general anaesthesia. Analysis of observational studies demonstrated that local anaesthesia was associated with a significantly lower incidence of stroke (odds ratio (OR (95% CI) 0.66 (0.55-0.80), p < 0.0001), transient ischaemic attack (0.52 (0.38-0.70), p < 0.0001), myocardial infarction (0.55 (0.41-0.75), p = 0.0002) and mortality (0.72 (0.56-0.94), p = 0.01) compared with general anaesthesia. Analysis of randomised controlled trials did not find a significant difference in the risk of stroke (0.92 (0.67-1.28), p = 0.63), transient ischaemic attack (2.20 (0.48-10.03), p = 0.31), myocardial infarction (1.25 (0.57-2.72), p = 0.58) or mortality (0.61 (0.35-1.05), p = 0.07) between local and general anaesthesia. On trial sequential analysis of the randomised trials, the Z-curve did not cross the α-spending boundaries or futility boundaries for stroke, mortality and transient ischaemic attack, suggesting that more trials are needed to reach conclusive results. Our meta-analysis of observational studies suggests that local anaesthesia for carotid endarterectomy may be associated with lower peri-operative morbidity and mortality compared with general anaesthesia. Although randomised studies have not confirmed any advantage for local anaesthesia, this may be due to a lack of pooled statistical power in these trials.

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Subclinical Neurocognitive Dysfunction After Carotid Endarterectomy—The Impact of Shunting

Cited by 25 publications

References 26 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

General Anesthesia Versus Local Anesthesia in Carotid Endarterectomy: A Systematic Review and Meta-Analysis

Meta‐analysis and trial sequential analysis of local vs. general anaesthesia for carotid endarterectomy

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