The effect of normotensive arterial pressure on cerebral saturation during carotid endarterectomy

Abstract

Aim: Monitoring of cerebral perfusion during carotid endarterectomy helps to institute early intervention to prevent risk of ischemia during the operation. We aimed to evaluate if the disadvantages of high systemic pressure can be avoided by keeping arterial blood pressure below 150 mmHg during cross-clamping of the internal carotid artery by correlating our findings of NIRS values with clinical results. Material and Method: This was designed as a prospective study that included elective patients scheduled for an operation of carotid artery stenosis under general anesthesia. A total of 60 patients operated on between August and October 2019 were included in the study. Results: Patients' NIRS findings on the right and left hemispheres were analyzed separately to be able to differentiate any possible changes of NIRS of the cerebral hemisphere ipsilateral to the clamped carotid artery. The analysis of the right and left NIRS findings in these 60 patients revealed a significant decrease between intubation and incision NIRS values (p=0.008 and p=0.02 respectively). Conclusion:Considering the NIRS findings and clinical observations of the patients in the postoperative period, we think that ICA endarterectomy operations may be safe to perform in a suitable patient group while the systolic arterial blood pressure is maintained below 150mmHg during cross-clamping.