scholarly journals Cerebral monitoring during carotid endarterectomy using transcranial cerebral oximetry

2020 ◽  
Vol 121 (06) ◽  
pp. 431-436
Author(s):  
V. Sihotsky ◽  
P. Berek ◽  
I. Kopolovets ◽  
M. Frankovicova ◽  
P. Stefanic ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Cerebral Oximetry ◽  
Cerebral Monitoring

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.

Noninvasive cerebral oximetry during carotid endarterectomy: application and results

2015 ◽  
Vol 22 (2) ◽  
pp. 55-60
Author(s):  
Eglė Kontrimavičiūtė ◽  
Vilma Kuzminskaitė ◽  
Jūratė Šipylaitė
Keyword(s):  
Carotid Endarterectomy ◽  
Cerebral Oxygenation ◽  
Brain Perfusion ◽  
University Hospital ◽  
Cerebral Oximetry ◽  
Neurologic Outcomes ◽  
Study Results ◽  
The Difference ◽  
Cerebral Monitoring ◽  
And Control

Background. Cerebral monitoring during carotid endarterectomy allows to detect brain hypoperfusion following carotid clamping and hyperperfusion after restoring the blood flow. Immediate corrections of these changes have the potential in reducing adverse neurologic outcomes. In this study we share our experience using cerebral oximetry in carotid endarterectomy surgery, as well as finding a connection between comorbidities and baseline cerebral oxygenation values. Materials and methods. A non-randomised perspective study was performed at Vilnius University Hospital Santariškių Clinics. During 2012–2013 all consecutive elective patients undergoing carotid surgery were enrolled in the study. Results. No difference was found in the baseline values on the operative and control sides (71.15% vs 76.76%, p = 0.15). After carotid clamping regional brain saturation decreased by 4.34% of the baseline on the operative side. During the clamping cerebral oxygenation was lower on the operative side (68.06% vs 77.32%, p = 0.03). Following carotid declamping the difference between operative and control side oxygenation diminished (73.57% vs 79.30%, p = 0.16). Neither diabetes nor peripheral atherosclerosis had influence on baseline cerebral oxygen saturation values. There was a tendency towards the lower cerebral oxygenation baseline for smokers (70.12% vs 76.54%, p = 0.103). Conclusions. Cerebral oximetry is a valuable method of cerebral monitoring reflecting changes in brain perfusion during carotid endarterectomy. Certain comorbidities might have a role in affecting baseline oximetry values.

scholarly journals Combined Stump Pressure and Oximetry for Shunt Use During Carotid Endarterectomy

2017 ◽  
Vol 44 (6) ◽  
pp. 692-696 ◽  
Author(s):  
J. Max Findlay ◽  
Rohit Kesarwani ◽  
Michael Jacka ◽  
B. Elaine Marchak
Keyword(s):  
General Anesthesia ◽  
Carotid Endarterectomy ◽  
Blood Supply ◽  
Cerebral Oximetry ◽  
Pressure Measurements ◽  
Stump Pressure ◽  
Vulnerable Patients ◽  
Study Population ◽  
Baseline Characteristics ◽  
Cerebral Monitoring

AbstractBackground:Cross-clamp ischemia during carotid endarterectomy can be prevented with carotid bypass shunts in vulnerable patients identified by cerebral monitoring for ischemia. We compared transcranial cerebral oximetry (TCO) with carotid stump pressure measurements for selective shunt use.Methods:We prospectively collected data on 300 consecutive patients operated on under general anesthesia between 2009 and 2016. Shunts were inserted for a 10% or greater drop in cerebral saturations and/or a mean stump pressure less than 40 mmHg.Results:Seventy-five patients, 25% of the study population, were shunted. The indication was a combined desaturation and stump pressure in 38 (50% of the shunted group), desaturation alone in 11 patients (15%), and a low stump pressure alone in 26 patients (35%). There were no significant differences in baseline characteristics between those patients who were or were not shunted, except angiographic collateral blood supply, which was more commonly identified in patients who were not shunted. A watershed infarct occurred in just one patient with borderline TCO and stump pressure measurements in whom a shunt was not used.Conclusions:There was poor concordance between TCO and stump pressures, but using both in determining the need for shunt use almost eliminated cross-clamp ischemia in this series of 300 carotid endarterectomy patients.

Clinical Evaluation of Near-Infrared Cerebral Oximetry in the Awake-Patient Carotid Endarterectomy

2007 ◽  
Vol 79 (8) ◽  
Author(s):  
Jacek Wojciechowski ◽  
Magdalena Sidorowicz ◽  
Krzysztof Szyndler ◽  
Łukasz Znaniecki ◽  
Marcin Trenkner ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Clinical Evaluation ◽  
Near Infrared ◽  
Cerebral Oximetry ◽  
Awake Patient

scholarly journals VESS03. Evaluating the Efficacy of Selective Shunting and Cerebral Monitoring During Carotid Endarterectomy Using the VQI Database

2016 ◽  
Vol 63 (6) ◽  
pp. 5S-6S
Author(s):  
Clay P. Wiske ◽  
Isibor Arhuidese ◽  
Mahmoud B. Malas ◽  
Robert B. Patterson
Keyword(s):  
Carotid Endarterectomy ◽  
Cerebral Monitoring

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.

The Use of Near-Infrared Cerebral Oximetry in Awake Carotid Endarterectomy

1998 ◽  
Vol 10 (2) ◽  
pp. 109-113 ◽  
Author(s):  
Robert E. Carlin MD, Surgical Resident ◽  
Daniel J. McGraw MD, Assistant Professor of ◽  
J.Robert Calimlim MD, Assistant Professor ◽  
Michael F. Mascia MD, MPH, Assistant Profess
Keyword(s):  
Carotid Endarterectomy ◽  
Near Infrared ◽  
Cerebral Oximetry

CEREBRAL OXIMETRY AND EVOKED POTENTIAL MONITORING FOR CAROTID ENDARTERECTOMY

1998 ◽  
Vol 89 (Supplement) ◽  
pp. 338A
Author(s):  
E. M. Nemoto ◽  
H. Yonas ◽  
A. Kassam ◽  
H. Cho ◽  
J. Balzer ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Evoked Potential ◽  
Cerebral Oximetry ◽  
Evoked Potential Monitoring ◽  
Potential Monitoring

A clinical evaluation of near-infrared cerebral oximetry in the awake patient to monitor cerebral perfusion during carotid endarterectomy

2005 ◽  
Vol 17 (6) ◽  
pp. 426-430 ◽  
Author(s):  
Andrea Rigamonti ◽  
Mara Scandroglio ◽  
Francesco Minicucci ◽  
Silvio Magrin ◽  
Andrea Carozzo ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Clinical Evaluation ◽  
Cerebral Perfusion ◽  
Near Infrared ◽  
Cerebral Oximetry ◽  
Awake Patient
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