Combined Stump Pressure and Oximetry for Shunt Use During Carotid Endarterectomy

Findlay, J. Max; Kesarwani, Rohit; Jacka, Michael J.; Marchak, B. Elaine

doi:10.1017/cjn.2017.210

Cited by 8 publications

(5 citation statements)

References 30 publications

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“…The measured value reflects the mix of the arterial and venous oxygen. [4] In patients undergoing CAE under local anesthesia, the cutoff value for stump pressure and NIRS value was determined to avoid neurological deficit. In previous studies, it has been suggested that an intraluminal shunt placement should be performed when the NIRS value after placement of the cross clamp is less than 10% or 20% and stump pressures are lower than 30 or 40 mmHg.…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, it has been suggested that an intraluminal shunt placement should be performed when the NIRS value after placement of the cross clamp is less than 10% or 20% and stump pressures are lower than 30 or 40 mmHg. [468]…”

Section: Discussionmentioning

confidence: 99%

“…The cutoff value for intraluminal shunt placement was accepted as 10% reduction (10% reduction from the previous value after cross-clamping) for NIRS and 40 mmHg for stump pressure. [4]…”

Section: Methodsmentioning

confidence: 99%

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The effect of cerebral oximeter use on the shunt placement concerning carotid endarterectomy surgery

Ceyhan¹,

Ovalı²

2019

Ann Card Anaesth

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Background: During carotid arterial endarterectomy (CAE) surgery, an intraluminal shunt is used to prevent hypoperfusion, which can be caused by a cross-clamping cerebral ischemia. However, routine shunt use is not recommended. Various cerebral monitoring techniques are used to determine the need for shunt placement. In this study, retrospective analysis of data on the efficacy of cerebral oximetry in the decision of shunt use during elective CAE surveys was planned. Materials and Methods: We collected data on 68 patients operated under general anesthesia between December 2016 and December 2017. Patients were evaluated for near infrared spectrometry (NIRS) and stump pressure values and whether shunt was placed or not. Results: Eight (11.7%) patients were shunting. NIRS value after cross-clamping was lower in patients with shunt. Stump pressure values were below 40 mmHg. Conclusions: Cerebral monitoring in elective CAE operations has great importance in determining the necessity of using intraluminal shunt to reduce the complications that may occur.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The effect of cerebral oximeter use on the shunt placement concerning carotid endarterectomy surgery

Ceyhan¹,

Ovalı²

2019

Ann Card Anaesth

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“…For many years, electroencephalograms (EEGs) and stump pressure have been used to monitor cerebral function and collateral cerebral flow during CEA. 31) Stump pressure <40 mmHg has been used as the threshold for defining cerebral ischemia. 32) Findlay et al 31) demonstrated CEA stump pressure <40 mmHg in 21% of 300 cases.…”

Section: Monitoring Technique In Ceamentioning

confidence: 99%

Surgical Technique for Carotid Endarterectomy: Current Methods and Problems

Uno

Takai

Yagi

et al. 2020

Neurol. Med. Chir.(Tokyo)

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Over the last 60 years, many reports have investigated carotid endarterectomy (CEA) and techniques have thus changed and improved. In this paper, we review the recent literature regarding operational maneuvers for CEA and discuss future problems for CEA. Longitudinal skin incision is common, but the transverse incision has been reported to offer minimal invasiveness and better cosmetic effects for CEA. Most surgeons currently use microscopy for dissection of the artery and plaque. Although no monitoring technique during CEA has been proven superior, multiple monitors offer better sensitivity for predicting postoperative neurological deficit. To date, data are lacking regarding whether routine shunt or selective shunt is better. Individual surgeons thus need to select the method with which they are more comfortable. Many surgical techniques have been reported to obtain distal control of the internal carotid artery in patients with high cervical carotid bifurcation or high plaque, and minimally invasive techniques should be considered. Multiple studies have shown that patch angioplasty reduces the risks of stroke and restenosis compared with primary closure, but few surgeons in Japan have been performing patch angioplasty. Most surgeons thus experience only a small volume of CEAs in Japan, so training programs and development of in vivo training models are important.

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“…kullanılan bu yöntemin noninvaziv oluşu, diğer yöntemlere kıyasla ucuz ve kolay uygulanabilirliği en önemli avantajlarıdır. Wang ve ark., kross klemp sonrası rSO2'deki %12.3, Jonsson ve ark., %9, Findlay ve ark., >%10 ve Kondov ve ark., >%15 azalmanın yüksek duyarlılık ve kabul edilebilir özgüllük ile güvenli bir eşik değer olduğunu belirtmişlerdir(17,18,19,14). Ancak NIRS'ın pozitif pretiktif değerinin zayıf olması ve serebral iskemi için net bir cut-off değerinin olmaması dezavantajıdır(20).…”

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Monitoring and Maintaining Cerebral Perfusion During Carotid Endarterectomy: Use of Selective Shunt Under NIRS and Root Pressure Guidance

Yazman

Depboylu

Harmandar

et al. 2022

Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi

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Karotis arter cerrahisinde endarterektomi ve eversiyon metotları semptomatik veya asemptomatik hastalarda inme ve mortalite oranını azaltmaya yönelik uygulanan düşük riskli altın standart tedavi yöntemleridir. Serebral hipoperfuzyon ve iskeminin erken tespiti için rejyonel serebral oksimetri (NIRS) ve karotis kök basıncı ölçümü yaygın kullanılan yöntemlerdir. Serebral hipoperfuzyonu engellemek ve serebral iskemi riskini azaltmak amaçlı en yaygın kullanılan yöntem intraoperatif şant kullanılmasıdır. Çalışmamızda NIRS ve karotis kök basıncı değerlerinin kombinasyonu ile şant kullanımına karar verilerek genel anestezi altında opere edilen karotis arter hastalarında şant kullanımının peroperatif inme ve mortalite üzerine etkilerini araştırmayı amaçladık. 2018 - 2020 yılları arasında NASCET kriterlerine göre %70-99 oranında darlık tespit edilen ve opere edilen 40 hasta retrospektif olarak değerlendirilmiştir. Şant kullanılan ve kullanılmayan grupta ipsilateral NIRS değerleri sırası ile ortalama klemp öncesi 70.33±8.40 ve 65.1±4.52, klemp konulduktan sonraki ilk dakikada 57.87±8.4 ve 62.01±4.6 saptandı (p%15 düşme ile kök basıncı değeri

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Combined Stump Pressure and Oximetry for Shunt Use During Carotid Endarterectomy

Abstract: 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.

Cited by 8 publications

References 30 publications

The effect of cerebral oximeter use on the shunt placement concerning carotid endarterectomy surgery

The effect of cerebral oximeter use on the shunt placement concerning carotid endarterectomy surgery

Surgical Technique for Carotid Endarterectomy: Current Methods and Problems

Monitoring and Maintaining Cerebral Perfusion During Carotid Endarterectomy: Use of Selective Shunt Under NIRS and Root Pressure Guidance

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