Outcome Analysis of Carotid Cross-Clamp Intolerance during Carotid Endarterectomy under Locoregional Anesthesia

Piffaretti, Gabriele; Tarallo, Antonino; Franchin, Marco; Bacuzzi, Alessandro; Rivolta, Nicola; Ferrario, Massimo; Ferraro, Stefania; Bossi, Matteo; Castelli, Patrizio; Tozzi, Matteo

doi:10.1016/j.avsg.2016.11.024

Cited by 14 publications

(6 citation statements)

References 47 publications

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“…Recently, in selective patients, carotis artery stending (CAS) has been used as alternative treatment for CEA who developed CCI during CEA. If patient has risk factors for CCI, GA is more suitable option as anaesthesic method because of risk for shunting or conversion to CAS (23) . On the other hand, Dellaretti et al demonstrated that locoregional anaesthesia is a safe method for identifying patients with CCI and the mean degree of contralateral carotis stenosis was associated with CCI (24) .…”

Section: Introductionmentioning

confidence: 99%

Anesthesia Management for Carotid Endarterectomy: Review Article

Yilmaz¹

2019

ejcm

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Atherosclerotic carotid artery disease is responsible from 20% to 25% of ischemic stroke events. Open carotid surgery and stent insertion are two main types of treatment procedures. Carotid endarterectomy (CEA) can be performed under general anaesthesia, regional anaesthesia (interscalen block, cervical plexus block either by landmark technique or by US guidance), combination of general and regional anaesthesia, regional anaesthesia with combination of periferic block. The aim of all anesthesic techniques is to prevent pain during the three painful periods (1. Skin incision, 2. Insertion of a retromandibular retractor, 3. Perivascular preparation) during CEA). All techniques have their own advantages and disadvantages. But there is no certain data about which one is superior to other. There is no consensus on anaesthetic choice for CEA. At present regional anaesthesia versus general anaesthesia for patients undergoing CEA is still debate topic. Improvements in medical theraphy, use of cerebral monitoring, better timing for surgery after ischemic events, better surgical techniques, increased use of ultrasound for regional anaesthesia improve procedural outcomes. Despite these improvements, anaesthesia management is still deciding according to surgeon and anaesthesiologist preferences, the patient's satisfaction and the conditions in the hospitals where we work.

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Section: Introductionmentioning

confidence: 99%

Anesthesia Management for Carotid Endarterectomy: Review Article

Yilmaz¹

2019

ejcm

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“…One modality for optimizing risk assessment is to use a predictive score but, currently, there are no mortality predictive scoring systems for single‐stage CVS and CEA 8,14,21,22 . The predictors identified in our series are reliable since they have been associated with mortality in other experiences.…”

Section: Discussionmentioning

confidence: 76%

“…The predictors identified in our series are reliable since they have been associated with mortality in other experiences. When it comes to the carotid revascularization component of this complex clinical scenario, the risk of neurologic complications has been correlated to the clinical relevance of the carotid stenosis, namely a history of stroke 15,22,23 . While there is no unquestionable evidence that the majority of patients undergoing coronary artery bypass grafting may benefit from CEA, high‐grade extra‐cranial carotid artery stenosis poses a higher risk of stroke than patients without carotid disease 1,2,23 .…”

Section: Discussionmentioning

confidence: 99%

“…When it comes to the carotid revascularization component of this complex clinical scenario, the risk of neurologic complications has been correlated to the clinical relevance of the carotid stenosis, namely a history of stroke. 15,22,23 While there is no unquestionable evidence that the majority of patients undergoing coronary artery bypass grafting may benefit from CEA, high-grade extra-cranial carotid artery stenosis poses a higher risk of stroke than patients without carotid disease. 1,2,23 The fact that stroke rate was lowest at 1.9% in the staged group of the vast cohort of the National Inpatient Sample may support this observation.…”

Section: Secondary Outcomesmentioning

confidence: 99%

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Predicting early mortality following single‐stage coronary artery or valve surgery and carotid endarterectomy

Franchin

Dorigo

et al. 2022

Journal of Cardiac Surgery

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Background Surgical management of coexisting cardiac disease and extra‐cranial carotid artery disease is a controversial area of debate. Thus, in this challenging scenario, risk stratification may play a key role in surgical decision making. Aim To report the results of single‐stage coronary/valve surgery (CVS) and carotid endarterectomy (CEA), and to identify predictive factors associated with 30‐day mortality. Methods This was a multicenter, retrospective study of prospectively maintained data from three academic tertiary referral hospitals. For this study, only patients treated with single‐stage CVS, meaning coronary artery bypass surgery or valve surgery, and CEA between March 1, 2000 and March 30, 2020, were included. Primary outcome measure of interest was 30‐day mortality. Secondary outcomes were neurologic events rate, and a composite endpoint of postoperative stroke/death rate. Results During the study period, there were 386 patients who underwent the following procedures: CEA with isolated coronary artery bypass graft in 243 (63%) cases, with isolated valve surgery in 40 (10.4%), and combination of coronary artery bypass grafting and valve surgery in 103 (26.7%). Postoperative neurologic event rate was 2.6% (n = 10) which includes 5 (1.3%) transient ischemic attacks and 5 (1.3%) strokes (major n = 3, minor n = 2). The 30‐day mortality rate was 3.9% (n = 15). Predictors of 30‐day mortality included preoperative left heart insufficiency (odds ratio [OR]: 5.44, 95% confidence interval [CI]: 1.63–18.17, p = .006), and postoperative stroke (OR: 197.11, 95% CI: 18.28–2124.93, p < .001). No predictor for postoperative stroke and for composite endpoint was identified. Conclusions Considering that postoperative stroke rate and mortality was acceptably low, single‐stage approach is an effective option in such selected high‐risk patients.

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“…The benefit of predicting the occurrence of IND during CACC in CEA relies on the fact that, although being a soft surgical outcome, it is interpreted as a sign of critical cerebral ischemia and it has already been shown to predispose to hard outcomes, such as stroke or other perioperative complications [ 8 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

The Gupta Perioperative Risk for Myocardial Infarct or Cardiac Arrest (MICA) Calculator as an Intraoperative Neurologic Deficit Predictor in Carotid Endarterectomy

Pereira-Macedo

Lopes-Fernandes²,

Duarte-Gamas³

et al. 2022

JCM

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Background: Patients undergoing carotid endarterectomy (CEA) may experiment intraoperative neurologic deficits (IND) during carotid cross-clamping. This work aimed to assess the impact of the Gupta Perioperative Myocardial Infarct or Cardiac Arrest (MICA) risk calculator in the IND. Methods: From January 2012 to April 2021, patients undergoing CEA with regional anaesthesia for carotid stenosis with IND and consecutively control operated patients without IND were selected. A regressive predictive model was created, and a receiver operating characteristic (ROC) curve was applied for comparison. A multivariable dependence analysis was conducted using a classification and regression tree (CRT) algorithm. Results: A total of 97 out of 194 included patients developed IND. Obesity showed aOR = 4.01 (95% CI: 1.66–9.67) and MICA score aOR = 1.21 (1.03–1.43). Higher contralateral stenosis showed aOR = 1.29 (1.08–1.53). The AUROC curve was 0.656. The CRT algorithm differentiated obese patients with a MICA score ≥ 8. Regarding non-obese patients, the model identified the presence of contralateral stenosis ≥ 55% with a MICA ≥ 10. Conclusion: MICA score might play an additional role in stratifying patients for IND in CEA. Obesity was determined as the best discrimination factor, followed by a score ≥ 8. A higher ipsilateral stenosis degree is suggested to have a part in avoiding procedure-related IND. Larger studies might validate the benefit of MICA score regarding the risk of IND.

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Outcome Analysis of Carotid Cross-Clamp Intolerance during Carotid Endarterectomy under Locoregional Anesthesia

Cited by 14 publications

References 47 publications

Anesthesia Management for Carotid Endarterectomy: Review Article

Anesthesia Management for Carotid Endarterectomy: Review Article

Predicting early mortality following single‐stage coronary artery or valve surgery and carotid endarterectomy

The Gupta Perioperative Risk for Myocardial Infarct or Cardiac Arrest (MICA) Calculator as an Intraoperative Neurologic Deficit Predictor in Carotid Endarterectomy

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