The Diagnostic Accuracy of Intra-Operative Near Infrared Spectroscopy in Carotid Artery Endarterectomy Under Regional Anaesthesia: Systematic Review and Meta-Analysis

Gamas, Luís; Sousa, Joel; Sousa‐Pinto, Bernardo; Rocha‐Neves, João

doi:10.1016/j.ejvs.2021.05.042

Cited by 14 publications

(8 citation statements)

References 32 publications

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“…Our case illustrates that even a 7% ipsilateral decrease can be associated with severe neurologic deficit. This is in line with a recent meta-analysis on the diagnostic accuracy of NIRS for cerebral ischemia in awake patients, which found a sensitivity of 72% and specificity of 84% when cut-off values of 9-25.8% were used, leading to the authors' conclusion that NIRS is not accurate enough to be used as a sole neuromonitoring modality [16]. With various options and no clear gold standard, the type of neuromonitoring used during CEA will often depend on availability and local expertise, and varies both regionally and internationally.…”

Section: Discussionsupporting

confidence: 84%

Perioperative stroke during carotid endarterectomy: benefits of multimodal neuromonitoring - a case report

2022

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Background Carotid endarterectomy is routinely performed after ischemic stroke due to carotid stenosis. Perioperative, cerebral blood flow and oxygenation can be monitored in different ways, but there is no clear evidence of a gold standard and a uniform guideline is lacking. Electroencephalography and near-infrared spectroscopy are among the most frequently used methods of neuromonitoring. Clinicians should be aware of their pitfalls and the added value of transcranial doppler. Case presentation We present the case of an 85-year old male with perioperative haemodynamic stroke during carotid endarterectomy. Ischemic stroke was caused by suddenly increased carotid stenosis resulting in major neurologic deficit. This was registered only by transcranial doppler, while surface electroencephalography and near-infrared spectroscopy failed to detect any significant change in cerebral perfusion, despite a large perfusion defect on computed tomography. Circulation was restored with endovascular treatment and neurologic deficit quickly resolved. Conclusion We strongly advocate the practice of multimodal neuromonitoring including transcranial doppler whenever possible to minimize the risk of persistent neurologic deficit due to perioperative stroke during carotid endarterectomy.

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Section: Discussionsupporting

confidence: 84%

Perioperative stroke during carotid endarterectomy: benefits of multimodal neuromonitoring - a case report

2022

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“…Additionally, the nearinfrared spectroscopy value that could be used to forecast postoperative cerebral ischemia could not be found by the authors. As there was no threshold effect in the range of cutoff values reported in the primary trials, the ideal cutoff that would benefit from the use of shunting could not be identified (20). Pennekamp et al reported that a 16% decrease in near-infrared spectroscopy had a positive predictive value of 76% and a negative predictive value of 99% for the detection of cerebral hypoperfusion in a prospective cohort study involving patients submitted to CEA under general anesthesia, suggesting that this method might be utilized to direct the use of selective shunts (21).…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the near-infrared spectroscopy value that could be used to forecast postoperative cerebral ischemia could not be found by the authors. As there was no threshold effect in the range of cutoff values reported in the primary trials, the ideal cutoff that would benefit from the use of shunting could not be identified ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Cerebral oximetry monitoring by means of INVOS-4100 as a predictor of ischemic events during carotid endarterectomy

et al. 2023

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BackgroundSeveral methods have been proposed to monitor cerebral perfusion during carotid endarterectomy (CEA), with the purpose of minimizing the risk of perioperative stroke. The INVOS-4100 is able to detect cerebral oxygen saturation providing an intraoperative real-time monitoring system of cerebral oximetry. The aim of this study was to evaluate the performance of the INVOS-4100 in predicting cerebral ischemia during CEA.MethodsBetween January 2020 and May 2022, 68 consecutive patients were scheduled for CEA either under general anesthesia or regional anesthesia with deep and superficial cervical block. Vascular oxygen saturation was recorded continually through INVOS before and during clamping of the ICA. Awake testing was performed in the group of patients undergoing CEA under regional anesthesia.ResultsSixty-eight patients were included; 43 were males (63.2%). Severe stenosis of the artery was present in 92%. Forty-one (60.3%) patients were monitored by INVOS, while 22 (39.7%) underwent awake testing. Mean clamping time was 20 ± 6.6 min. Patients undergoing awake testing had a lower hospital stay and ICU stay during admission (p = 0.011 and p = 0.007 respectively). Comorbidities correlated with a higher ICU stay (p < 0.05). The INVOS monitoring was able to predict ischemic events with a sensitivity of 98% (AUC = 0.976).ConclusionsThe present study demonstrates that cerebral oximetry monitoring was a strong predictor of cerebral ischemia, although it was not possible to determine the non-inferiority of cerebral oximetry compared to awake testing. Nonetheless, the use of cerebral oximetry evaluates only perfusion in the superficial brain tissue and an absolute rSO2 value corresponding to significant cerebral ischemia has not been established. Therefore, larger prospective studies that correlate cerebral oximetry with neurologic outcomes are needed.

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“…Near-infrared spectroscopy (NIRS) is a method of the microcirculation evaluation used in case of brain blood flow, including during a perioperative management [40]. The change of hemoglobin oxygenation is evaluated.…”

Section: Near-infrared Spectroscopy (Nirs)mentioning

confidence: 99%

Methods for the assessment of microcirculation in patients with hypertension

Lewandowska

Marzyńska

Rzesoś

et al. 2023

Arterial Hypertension

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Arterial hypertension (HT) is one of the most common lifestyle diseases worldwide, including Poland. According to World Health Organization, as many as 1.28 billion adults worldwide were suffering from HT in 2011 -a half were unaware of their disease. It is claimed that approximately 10 million of deaths annually are the result of improperly high blood pressure values (BP) [1]. It is estimated that the number of HT patients will exceed 1.5 billion by 2025. Therefore, it classifies HT as a major global healthcare problem [2].According to the WOBASZ II study, more than 40% of the adult Polish population were diagnosed with HT. A constantly increasing trend of newly di-

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The Diagnostic Accuracy of Intra-Operative Near Infrared Spectroscopy in Carotid Artery Endarterectomy Under Regional Anaesthesia: Systematic Review and Meta-Analysis

Cited by 14 publications

References 32 publications

Perioperative stroke during carotid endarterectomy: benefits of multimodal neuromonitoring - a case report

Perioperative stroke during carotid endarterectomy: benefits of multimodal neuromonitoring - a case report

Cerebral oximetry monitoring by means of INVOS-4100 as a predictor of ischemic events during carotid endarterectomy

Methods for the assessment of microcirculation in patients with hypertension

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