Critical analysis of the literature and standards of reporting on stroke after carotid revascularization

Coelho, Andreia; Peixoto, João; Canedo, Alexandra; Kappelle, L. Jaap; Mansilha, Armando; Borst, Gert J. de

doi:10.1016/j.jvs.2021.05.055

Cited by 10 publications

(6 citation statements)

References 38 publications

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“…The 6 patients who displayed a postoperative ischemic event developed a non-disabling minor stroke or transient ischemic attack. The overall rate in our cohort of patients was 8.8% which is consistent with the incidence of ischemic events of 10.2% following CEA reported in the literature ( 16 , 17 ).…”

Section: Discussionsupporting

confidence: 91%

Cerebral oximetry monitoring by means of INVOS-4100 as a predictor of ischemic events during carotid endarterectomy

et al. 2023

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BackgroundSeveral methods have been proposed to monitor cerebral perfusion during carotid endarterectomy (CEA), with the purpose of minimizing the risk of perioperative stroke. The INVOS-4100 is able to detect cerebral oxygen saturation providing an intraoperative real-time monitoring system of cerebral oximetry. The aim of this study was to evaluate the performance of the INVOS-4100 in predicting cerebral ischemia during CEA.MethodsBetween January 2020 and May 2022, 68 consecutive patients were scheduled for CEA either under general anesthesia or regional anesthesia with deep and superficial cervical block. Vascular oxygen saturation was recorded continually through INVOS before and during clamping of the ICA. Awake testing was performed in the group of patients undergoing CEA under regional anesthesia.ResultsSixty-eight patients were included; 43 were males (63.2%). Severe stenosis of the artery was present in 92%. Forty-one (60.3%) patients were monitored by INVOS, while 22 (39.7%) underwent awake testing. Mean clamping time was 20 ± 6.6 min. Patients undergoing awake testing had a lower hospital stay and ICU stay during admission (p = 0.011 and p = 0.007 respectively). Comorbidities correlated with a higher ICU stay (p < 0.05). The INVOS monitoring was able to predict ischemic events with a sensitivity of 98% (AUC = 0.976).ConclusionsThe present study demonstrates that cerebral oximetry monitoring was a strong predictor of cerebral ischemia, although it was not possible to determine the non-inferiority of cerebral oximetry compared to awake testing. Nonetheless, the use of cerebral oximetry evaluates only perfusion in the superficial brain tissue and an absolute rSO2 value corresponding to significant cerebral ischemia has not been established. Therefore, larger prospective studies that correlate cerebral oximetry with neurologic outcomes are needed.

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Section: Discussionsupporting

confidence: 91%

Cerebral oximetry monitoring by means of INVOS-4100 as a predictor of ischemic events during carotid endarterectomy

et al. 2023

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“…This classification is based on few clinical variables: time of the event after the carotid procedure, affected brain territory, and severity of the ischemic event. (15) Knowing the real incidence of this event through a compulsory notification may be the best way to improve patient outcomes, especially with the implementation of protocols for early recognition and intervention. (16) Studies on amputations after revascularization for PAD have reported that amputation rates after lower limb revascularization procedures vary between 0 and 7%.…”

Section: Stroke After Carotid Revascularizationmentioning

confidence: 99%

Proposed public policies to improve outcomes in vascular surgery: an experts’ forum

Wolosker¹,

Louzada²,

Portela³

et al. 2023

Einstein (São Paulo)

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“…The definition of perioperative stroke is the following: any embolic, thrombotic, or hemorrhagic cerebrovascular event with motor, sensory, or cognitive dysfunction lasting at least 24 h, occurring intraoperatively or within 30 days after surgery [18]. However, the risk of perioperative neurological events most frequently arises from diminished cerebrovascular reserve capacity, typically resulting in hypoperfusion-induced ischemia or procedural factors, rather than embolization linked to plaque-related mechanisms [19]. In our review, we focus on the risk assessment of perioperative neurological events caused by impaired cerebrovascular reserve capacity in patients with asymptomatic carotid artery stenosis.…”

Section: Introductionmentioning

confidence: 99%

Non-Invasive Tools in Perioperative Stroke Risk Assessment for Asymptomatic Carotid Artery Stenosis with a Focus on the Circle of Willis

Lengyel,

Magyar-Stang,

Pál

et al. 2024

JCM

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This review aims to explore advancements in perioperative ischemic stroke risk estimation for asymptomatic patients with significant carotid artery stenosis, focusing on Circle of Willis (CoW) morphology based on the CTA or MR diagnostic imaging in the current preoperative diagnostic algorithm. Functional transcranial Doppler (fTCD), near-infrared spectroscopy (NIRS), and optical coherence tomography angiography (OCTA) are discussed in the context of evaluating cerebrovascular reserve capacity and collateral vascular systems, particularly the CoW. These non-invasive diagnostic tools provide additional valuable insights into the cerebral perfusion status. They support biomedical modeling as the gold standard for the prediction of the potential impact of carotid artery stenosis on the hemodynamic changes of cerebral perfusion. Intraoperative risk assessment strategies, including selective shunting, are explored with a focus on CoW variations and their implications for perioperative ischemic stroke and cognitive function decline. By synthesizing these insights, this review underscores the potential of non-invasive diagnostic methods to support clinical decision making and improve asymptomatic patient outcomes by reducing the risk of perioperative ischemic neurological events and preventing further cognitive decline.

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Critical analysis of the literature and standards of reporting on stroke after carotid revascularization

Cited by 10 publications

References 38 publications

Cerebral oximetry monitoring by means of INVOS-4100 as a predictor of ischemic events during carotid endarterectomy

Cerebral oximetry monitoring by means of INVOS-4100 as a predictor of ischemic events during carotid endarterectomy

Proposed public policies to improve outcomes in vascular surgery: an experts’ forum

Non-Invasive Tools in Perioperative Stroke Risk Assessment for Asymptomatic Carotid Artery Stenosis with a Focus on the Circle of Willis

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