scholarly journals Accuracy of Cerebral Monitoring in Detecting Cerebral Ischemia during Carotid Endarterectomy

2007 ◽  
Vol 107 (4) ◽  
pp. 563-569 ◽  
Author(s):  
Stefan Moritz ◽  
Piotr Kasprzak ◽  
Matthias Arlt ◽  
Kai Taeger ◽  
Christoph Metz
Keyword(s):  
Cerebral Ischemia ◽  
Carotid Endarterectomy ◽  
Transcranial Doppler Sonography ◽  
Percentage Change ◽  
Carotid Surgery ◽  
Characteristic Analysis ◽  
Neurologic Deterioration ◽  
Lower Accuracy ◽  
Significant Difference ◽  
Cerebral Monitoring

Background This study compares the accuracy of cerebral monitoring systems in detecting cerebral ischemia during carotid endarterectomy. Methods The authors compared transcranial Doppler sonography (TCD), near-infrared spectroscopy (NIRS), stump pressure (SP) measurement, and somatosensory evoked potentials (SEP) in 48 patients undergoing carotid surgery during regional anesthesia. Cerebral ischemia was assumed when neurologic deterioration occurred. During clamping, the minimum mean middle cerebral artery velocity (TCD(min)), its percentage change (TCD%), the minimum regional saturation of oxygen (NIRS(min)), its percentage change (NIRS%), the mean SP, and the changes of SEP amplitude were recorded. To analyze the corresponding sensitivity and specificity of each parameter, the authors performed receiver operating characteristic analysis. Results Neurologic deterioration occurred in 12 patients. SP and NIRS were successfully performed in all patients. TCD monitoring was not possible in 10 (21%); SEP was not possible in 2 patients (4%). All parameters provided the ability to distinguish between ischemic and nonischemic patients. TCD% and NIRS% showed significantly better discrimination than TCD(min) and NIRS(min) (P < 0.05). The highest area under the curve (AUC) was found for TCD% (AUC = 0.973), but there was no significant difference compared with NIRS% (AUC = 0.905) and SP (AUC = 0.925). The lowest AUC was found for SEP (AUC = 0.749), which was significantly lower than that for TCD%, NIRS%, and SP. Conclusions TCD%, NIRS%, and SP measurement provide similar accuracy for the detection of cerebral ischemia during carotid surgery. Lower accuracy was found for SEP monitoring. Because of the high rate of technical difficulties (21%), TCD monitoring was the least practical of the investigated monitoring devices.

Cerebral oximetry and stump pressure as indicators for shunting during carotid endarterectomy: comparative evaluation

Vascular ◽  
2011 ◽  
Vol 19 (4) ◽  
pp. 187-194 ◽  
Author(s):  
Charalambos L Tambakis ◽  
George Papadopoulos ◽  
Theodoros N Sergentanis ◽  
Nikolaos Lagos ◽  
Eleni Arnaoutoglou ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Operating Characteristic ◽  
Internal Carotid ◽  
Cerebral Oxygenation ◽  
Cerebral Oximetry ◽  
Characteristic Analysis ◽  
Shunt Insertion ◽  
Stump Pressure ◽  
Baseline Recording ◽  
Cerebral Monitoring

The purpose of this work is to investigate the correlation between regional oxygen saturation (rSO2) changes and stump pressure (SP) during cross-clamping of the internal carotid artery in carotid endarterectomy (CEA) and verify the perspectives of rSO2 to become a criterion for shunting. Sixty consecutive CEAs under general anesthesia were studied prospectively. Selective shunting was based on SP ≤40 mmHg exclusively. Regression analysis with high order terms and receiver operating characteristic analysis were performed to investigate the association between ΔrSO2(%) and SP and to determine an optimal ΔrSO2(%) threshold for shunt insertion. A quadratic association between ΔrSO2(%) and SP was documented regarding the baseline to one and five minutes after cross-clamping intervals. A cut-off of 21 and 10.1% reduction from the baseline recording was identified as optimal for the distinction between patients needed or not a shunt regarding the first and fifth minute after cross-clamping, respectively. In conclusion, cerebral oximety reflects sufficiently cerebral oxygenation during CEA compared with SP, providing a useful mean for cerebral monitoring.

scholarly journals Registry report on prediction by Pocock cardiovascular score of cerebral microemboli acutely following carotid endarterectomy

2018 ◽  
Vol 3 (3) ◽  
pp. 147-152
Author(s):  
Mahmud Saedon ◽  
Athanasios Saratzis ◽  
Rachel W S Lee ◽  
Charles E Hutchinson ◽  
Christopher H E Imray ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Carotid Endarterectomy ◽  
High Rate ◽  
Carotid Surgery ◽  
University Hospitals ◽  
Clinical Tool ◽  
Characteristic Analysis ◽  
Symptomatic Carotid ◽  
Asymptomatic Patients ◽  
Symptomatic Carotid Stenosis

BackgroundCerebral microemboli may lead to ischaemic neurological complications after carotid endarterectomy (CEA). The association between classical cardiovascular risk factors and acute cerebral microemboli following carotid surgery has not been studied. The aim of this study was to explore whether an established cardiovascular risk score (Pocock score) predicts the presence of cerebral microemboli acutely after CEA.Subjects and methodsPocock scores were assessed for the 670 patients from the Carotid Surgery Registry (age 71±1 (SEM) years, 474 (71%) male, 652 (97%) Caucasian) managed from January 2002 to December 2012 in the Regional Vascular Centre at University Hospitals Coventry and Warwickshire NHS Trust, which serves a population of 950 000. CEA was undertaken in 474 (71%) patients for symptomatic carotid stenosis and in 196 (25%) asymptomatic patients during the same period. 74% of patients were hypertensive, 71% were smokers and 49% had hypercholesterolaemia.ResultsA high Pocock score (≥2.3%) was significantly associated with evidence of cerebral microemboli acutely following CEA (P=0.039, Mann-Whitney (MW) test). A Pocock score (≥2.3%) did not predict patients who required additional antiplatelet therapy (microemboli signal (MES) rate >50 hour-1: P=0.164, MW test). Receiver operating characteristic analysis also showed that the Pocock score predicts acute postoperative microemboli (area under the curve (AUC) 0.546, 95% CI 0.502 to 0.590, P=0.039) but not a high rate of postoperative microemboli (MES >50 hour−1: AUC 0.546, 95% CI 0.482 to 0.610, P=0.164). A Pocock score ≥2.3% showed a sensitivity of 74% for the presence of acute postoperative cerebral microemboli. A Pocock score ≥2.3% also showed a sensitivity of 77% and a negative predictive value of 90% for patients who developed a high microembolic rate >50 hour−1 after carotid surgery.ConclusionThese findings demonstrate that the Pocock score could be used as a clinical tool to identify patients at high risk of developing acute postoperative microemboli.

Cardiovascular: Carotid Endarterectomy

2018 ◽  
pp. 189-196
Author(s):  
Ruchir Gupta
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebral Ischemia ◽  
Carotid Endarterectomy ◽  
Main Topic ◽  
Transient Ischemic Attacks ◽  
Neurological Assessment ◽  
Flow Management ◽  
Intraoperative Management ◽  
Cerebral Monitoring

In this chapter the essential aspects of anesthesia for carotid endarterectomy are discussed. Subtopics include transient ischemic attacks, cerebral monitoring, shunt placement, and cerebral blood flow management. The chapter is divided into preoperative, intraoperative and postoperative sections with important subtopics related to the main topic in each section. Preoperative topics include cardiac and neurological assessment and taking into account the patient’s hypertension. Issues discussed related to intraoperative management include considerations regarding use of general or regional anesthesia in this case, monitoring with electroencephalography, induction, and addressing cerebral ischemia. Postoperative concerns discussed are postoperative airway distress, potential hematoma, and treating hypertension.

Regional Cervical Plexus Blockage for Carotid Endarterectomy in Patients with Cardiovascular Risk Factors

2015 ◽  
Vol 18 (4) ◽  
pp. 140 ◽  
Author(s):  
Mehmet Taşar ◽  
Mehmet Kalender ◽  
Okay Güven Karaca ◽  
Ata Niyazi Ecevit ◽  
Salih Salihi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Carotid Endarterectomy ◽  
Regional Anesthesia ◽  
Carotid Artery Disease ◽  
Risk Groups ◽  
Cardiac Risk ◽  
Cervical Plexus ◽  
Cardiac Risk Factors ◽  
Significant Difference

Background: Carotid artery disease is not rare in cardiac patients. Patients with cardiac risk factors and carotid stenosis are prone to neurological and cardiovascular complications. With cardiac risk factors, carotid endarterectomy operation becomes challenging. Regional anesthesia is an alternative option, so we aimed to investigate the operative results of carotid endarterectomy operations under regional anesthesia in patients with cardiac risk factors. <br />Methods: We aimed to analyze and compare outcomes of carotid endarterectomy under regional anesthesia with cardiovascular risk groups retrospectively. Between 2006 and 2014, we applied 129 carotid endarterectomy ± patch plasty to 126 patients under combined cervical plexus block anesthesia. Patients were divided into three groups (high, moderate, low) according to their cardiovascular risks. Neurological and cardiovascular events after carotid endarterectomy were compared.<br />Results: Cerebrovascular accident was seen in 7 patients (5.55%) but there was no significant difference between groups (P &gt; .05). Mortality rate was 4.76% (n = 6); it was higher in the high risk group and was not statistically significant (P = .180). Four patients required revision for bleeding (3.17%). We did not observe any postoperative surgical infection.<br />Conclusion: Carotid endarterectomy can be safely performed with regional cervical anesthesia in all cardiovascular risk groups. Comprehensive studies comparing general anesthesia and regional anesthesia are needed. <br /><br />

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