scholarly journals P.118 An experience with combined cerebral oximetry and stump pressure measurement to guide shunt insertion during carotid endarterectomy

2016 ◽  
Vol 43 (S2) ◽  
pp. S47-S47
Author(s):  
R Kesarwani ◽  
M Findlay
Keyword(s):  
Blood Flow ◽  
Carotid Endarterectomy ◽  
Pressure Measurement ◽  
Intraoperative Monitoring ◽  
Cerebral Oximetry ◽  
Cerebral Oxygen ◽  
Collateral Blood Flow ◽  
Shunt Insertion ◽  
Perioperative Stroke ◽  
Stump Pressure

Background: Cross-clamp ischemia during carotid endarterectomy (CEA) can cause perioperative stroke. Selectively shunting patients based on intraoperative monitoring modalities that assess risk for ischemia can reduce the occurrence of immediate stroke. An experience with combined cerebral oximetry and stump pressure measurement to direct selective shunting is presented here. Methods: Study comparing intraoperative monitoring data, the decision to shunt, and presence of immediate post-operative deficits. Patients were shunted if either cerebral oxygen saturation dropped by more than 10% by cerebral oximetry, or stump pressure during cross-clamping was less than 40 mmHg. Cross-clamp ischemia was determined by the presence of ipsilateral neurological deficit upon awakening. Results: 245 patients were included in this study. 22% were shunted. Patients who were not shunted were significantly more likely to have collateral blood flow detected on angiography. Immediate post-operative stroke was not encountered in any of the patients included in the study. One patient who met shunting criteria but was excluded since he could not have a shunt inserted due to difficult anatomy did suffer stroke. Conclusions: With the dual-monitoring criteria presented here, 22% of patients were shunted. With the exception of one patient who could not have a shunt placed, no immediate post-operative stroke was encountered.

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 Effect of Carotid Endarterectomy on Primary Collateral Blood Flow in Patients With Severe Carotid Artery Lesions

Stroke ◽  
2003 ◽  
Vol 34 (7) ◽  
pp. 1650-1654 ◽  
Author(s):  
Jeroen Hendrikse ◽  
Dirk R. Rutgers ◽  
Catharina J.M. Klijn ◽  
Bert C. Eikelboom ◽  
Jeroen van der Grond
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Collateral Blood Flow ◽  
Carotid Artery Lesions

scholarly journals Manajemen Neuroanestesi pada Operasi Carotid Endarterectomy: Pasien dengan Riwayat Stroke Berulang

2021 ◽  
Vol 10 (1) ◽  
pp. 22-28
Author(s):  
Chrismas Gideon Bangun ◽  
◽  
RR Sinta Irina ◽  
Dewi Yulianti Bisri ◽  
Eri Surachman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Flow ◽  
Carotid Endarterectomy ◽  
Intraoperative Monitoring ◽  
Recurrent Stroke ◽  
Perioperative Complications ◽  
Eeg Monitoring ◽  
Carotid Disease ◽  
Leg Weakness ◽  
Electroencephalogram Eeg

Carotid endarterectomy (CEA) is a surgical procedure performed to restore carotid blood flow and reduce the incidence of embolic and thrombotic strokes. Although it is a preventive procedure, CEA carries the risk of perioperative complications: neurologic and cardiac. Major complications of CEA are intra and postoperative stroke, myocardial infarction, and death. To reduce the number of intraoperative stroke events, one of them is to develop intraoperative monitoring technology with electroencephalogram (EEG). In this case, a male patient, 62 years old, with statistics of recurrent stroke and left leg weakness was approved for CEA under general anesthesia. Surgeons decide to use shunt selectively by assessing EEG monitoring when clamping. Finally the shunt was not performed, the operation lasted for 6 hours, tinged with hemodynamic shocks that often occur in patients with carotid disease due to baroreceptor disorders. By managing anesthesia meticulously during and after surgery, the operation was successfully performed, and the results of the post on the left leg strengthening motor increased from 2 to 4.

Internal Carotid Artery Stump Pressure and Cerebral Blood Flow during Carotid Endarterectomy

1976 ◽  
Vol 45 (4) ◽  
pp. 390-399 ◽  
Author(s):  
Robert D. McKay ◽  
Thoralf M. Sundt ◽  
John D. Michenfelder ◽  
Gerald A. Gronert ◽  
Joseph M. Messick ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Stump Pressure

scholarly journals Cerebral Perfusion and Cerebral Protection during Carotid Endarterectomy

1983 ◽  
Vol 11 (3) ◽  
pp. 228-236 ◽  
Author(s):  
W. J. McMeniman ◽  
P. C. A. Kam
Keyword(s):  
Carotid Endarterectomy ◽  
Cerebral Perfusion ◽  
Cerebral Oxygen ◽  
Oxygen Requirement ◽  
Flow Measurements ◽  
Temporary Bypass ◽  
Relative Safety ◽  
Stump Pressure ◽  
Surgical Expertise ◽  
Blood Flow Measurements

The relative safety of carotid endarterectomy depends upon surgical expertise combined with appropriate monitoring of cerebral perfusion and the ability to intervene either surgically or pharmacologically to match cerebral perfusion to cerebral oxygen requirement. Methods of monitoring adequacy of cerebral perfusion are reviewed and include regional cerebral blood flow measurements, electroencephalographic monitoring, carotid stump pressure measurements, jugular venous oxygen partial pressure, neurological assessment and plethysmographic techniques. When cerebral perfusion is inadequate, such procedures as insertion of a temporary bypass shunt and maintenance of normocarbia may improve cerebral perfusion. Anticoagulants along with pharmacologic intervention to either increase cerebral perfusion pressure or reduce cerebral oxygen requirement may be used to preserve cerebral function.

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