Cerebral monitoring in patients undergoing carotid endarterectomy using a triple assessment technique

Ali, Ahmed; Green, David; Zayed, Hany; Halawa, Mustafa; El-sakka, Karim; Rashid, Hisham

doi:10.1510/icvts.2010.235598

Cited by 51 publications

(46 citation statements)

References 18 publications

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“…These results are similar to a previous study published by our group. 10 We found similar results with exclusive EEG monitoring. EEG changes alone had a high specificity of 90.33% but an even lower sensitivity of 28.57% when compared to exclusive SSEP.…”

Section: Discussionsupporting

confidence: 82%

“…9 Older studies performed to determine the accuracy of these various monitoring techniques have yielded mixed results and lower sensitivities with each method having its own limitations. 10,11 Although the combined utilization of more than one modality has been studied previously, these studies involved small patient populations. 12 Because of this lack of accuracy, acceptance of any one particular or a combination of techniques as the monitoring standard for CEA has not been adopted.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic accuracy of somatosensory evoked potential and electroencephalography during carotid endarterectomy

Natarajan

Thiagarajan

Crammond

et al. 2016

Neurological Research

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of somatosensory evoked potential and electroencephalography during carotid endarterectomy

Natarajan

Thiagarajan

Crammond

et al. 2016

Neurological Research

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“…Several report rScO 2 during carotid surgery (Williams et al, 1994a,b,c, 1999; Duncan et al, 1995; Kuroda et al, 1996a; Mead et al, 1996; Samra et al, 1996; Duffy et al, 1997; Beese et al, 1998; Carlin et al, 1998; de Letter et al, 1998; Fearn et al, 2000; Takeda et al, 2000; Kawada et al, 2002; Cuadra et al, 2003; Ogasawara et al, 2003; Vets et al, 2004; Komoribayashi et al, 2006; Yamamoto et al, 2007; Ishigaki et al, 2008; Lee et al, 2008; Stoneham et al, 2008; Kobayashi et al, 2009; Giustiniano et al, 2010; Moritz et al, 2010; Ali et al, 2011; Ritter et al, 2011; Pedrini et al, 2012; Uchino et al, 2012). …”

Section: Resultsmentioning

confidence: 99%

Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery

Nielsen

2014

Front. Physiol.

124

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Near-infrared spectroscopy (NIRS) is used to monitor regional cerebral oxygenation (rScO2) during cardiac surgery but is less established during non-cardiac surgery. This systematic review aimed (i) to determine the non-cardiac surgical procedures that provoke a reduction in rScO2 and (ii) to evaluate whether an intraoperative reduction in rScO2 influences postoperative outcome. The PubMed and Embase database were searched from inception until April 30, 2013 and inclusion criteria were intraoperative NIRS determined rScO2 in adult patients undergoing non-cardiac surgery. The type of surgery and number of patients included were recorded. There was included 113 articles and evidence suggests that rScO2 is reduced during thoracic surgery involving single lung ventilation, major abdominal surgery, hip surgery, and laparoscopic surgery with the patient placed in anti-Tredelenburg's position. Shoulder arthroscopy in the beach chair and carotid endarterectomy with clamped internal carotid artery (ICA) also cause pronounced cerebral desaturation. A >20% reduction in rScO2 coincides with indices of regional and global cerebral ischemia during carotid endarterectomy. Following thoracic surgery, major orthopedic, and abdominal surgery the occurrence of postoperative cognitive dysfunction (POCD) might be related to intraoperative cerebral desaturation. In conclusion, certain non-cardiac surgical procedures is associated with an increased risk for the occurrence of rScO2. Evidence for an association between cerebral desaturation and postoperative outcome parameters other than cognitive dysfunction needs to be established.

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“…The most reliable monitoring of cerebral ischemia is the continuous assessment of neurocognitive function in the awake patient, given the sensitivity of brain tissue even to very brief periods of ischemia and hypoxia [10,11]. This type of monitoring requires us to carry out the operation under local or regional anaesthesia.…”

Section: Awake Patientmentioning

confidence: 99%

Carotid Stenosis and Anaesthesia

Jj¹,

A²,

Jl³

et al. 2016

Int J Surg Surgical Proced

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EpidemiologyThe importance of carotid stenosis approach lies in the relationship it has with ischemic stroke, since it is present in 10-20% of all of them. This is of magnitude when we know that in Western countries, stroke is the third leading cause of death, behind only heart disease and cancer, with a mortality ranging from 10 to 30%, having survivors risk of recurring ischemic cardiac or neurologic events, so much so that is the leading cause of disability. The prevalence of stenosis in the internal carotid artery (ICA) is high and furthermore increases with age, in fact more than 50% stenosis rises from 0.5% in people aged between 50 and 59 years to 10% in those over 80 years. The primary mechanism involved in stroke in patients with carotid stenosis is embolism of atherosclerotic or thrombotic waste material from the plate to the distal cerebral vasculature. Infiltration of inflammatory cells on the surface of carotid plaques can play a key role in causing plaque rupture and embolization or occlusion of the carotid and also hemodynamic factors are correlated with increased risk of stroke in patients with carotid stenosis [1,2,3]. Of all the factors studied, the degree of arterial stenosis has emerged as the most directly related to the increased risk of stroke. Any diagnostic strategy, whatever the technique used, should have as its primary objective to determine, in the most accurate way, the amount of this stenosis [4].In the NASCET study the risk of ipsilateral recurrent stroke in patients with symptomatic carotid stenosis treated conservatively was 4.4% per year for patients with stenosis between 50 and 69% and 13% per year for those with 70% stenosis. The risk in patients with asymptomatic stenosis of 60% was around 1-2%, but could rise to 3-4% per year in elderly patients or in the presence of stenosis or occlusion of the contralateral artery, evidence of silent embolization in an imaging test, heterogeneity of the carotid plaque, poor collateral circulation, generalized inflammatory state or peripheral or coronary artery disease associated [5]. Treatment Medical versus interventional treatmentGiven the above discussion, we will assume that the main objective in the treatment of carotid stenosis is the prevention of ischemic stroke and its aftermath, regardless of the type of patient, the presence or absence of symptoms and the degree of stenosis. However, despite the clarity of the target it is unclear what therapeutic option to choose among only medical treatment or revascularization and, in the latter case, between endoluminal or surgical treatment. We will be guided in this review [6], considering that these guidelines place more emphasis on stroke prevention in the prevention of ischemic heart disease, on the grounds that according to the CREST study, stroke has shown greater impact on quality of life of the patient than nonfatal myocardial ischemia [7].The major determinants of the clinical course are the presence or absence of neurological symptoms and the degree of stenosis. The threat of isc...

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Cerebral monitoring in patients undergoing carotid endarterectomy using a triple assessment technique

Abstract: TCD is less accurate than CO in predicting the need for carotid shunting during CEA. A combination of both methods does not add to the accuracy of detecting the need for carotid shunting.

Cited by 51 publications

References 18 publications

Diagnostic accuracy of somatosensory evoked potential and electroencephalography during carotid endarterectomy

Diagnostic accuracy of somatosensory evoked potential and electroencephalography during carotid endarterectomy

Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery

Carotid Stenosis and Anaesthesia

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