Prospective evaluation of electroencephalography, carotid artery stump pressure, and neurologic changes during 314 consecutive carotid endarterectomies performed in awake patients

Hans, Sachinder Singh; Jareunpoon, Olan

doi:10.1016/j.jvs.2006.11.035

Cited by 131 publications

(94 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…EEG can provide continuous information on neuronal function and may help identify situations that require more aggressive elevation of CPP. The relationship between EEG changes and cerebral blood flow has been demonstrated previously, and there is extensive literature on the use of EEG for intra-operative monitoring, for example, during carotid endarterectomy [20][21][22][23][24][25][26][27][28]. Previous studies have clearly documented a relationship between cerebral blood flow and EEG changes [21,25,29].…”

Section: Discussionmentioning

confidence: 71%

Quantitative EEG Correlates of Low Cerebral Perfusion in Severe Stroke

et al. 2009

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 71%

Quantitative EEG Correlates of Low Cerebral Perfusion in Severe Stroke

et al. 2009

View full text Add to dashboard Cite

show abstract

“…Monitoring will include neurological status, orientation, language, muscle strength, sensation and calculation. The main advantage of this monitor is its sensitivity and specificity, even resulting in a cohort study more sensitive and specific identifying candidates for shunting than the electroencephalography (EEG) and the stump pressure [12,13].…”

Section: Awake Patientmentioning

confidence: 99%

Carotid Stenosis and Anaesthesia

Jj¹,

A²,

Jl³

et al. 2016

Int J Surg Surgical Proced

View full text Add to dashboard Cite

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...

show abstract

“…However, preoperative imaging and perioperative monitoring are notoriously poor predictors of patient response during intraoperative manipulation, including carotid cross-clamping during carotid surgery or selective antegrade cerebral perfusion during aortic arch surgery. 5,6 This study examines the relative contribution of cerebrovascular anatomy and physiology in maintaining adequate hemispheric perfusion, specifically by quantifying the population at risk of poor cerebral cross-perfusion due to anatomical circle of Willis deficiencies, and comparing it to the population that required shunting during carotid cross-clamping.…”

mentioning

confidence: 99%

“…Using this technique, shunt rates are around 20%; however, false positives are 1.45%, and negatives are 70.4%. 5 Transcranial Doppler is performed by setting the probe to monitor the flow in the ipsilateral middle cerebral artery and monitoring for changes in peak systolic velocity. Using this technique, shunt rates are 11%; however, false positives are 2%, and negatives are 29%.…”

mentioning

confidence: 99%

“…Using this technique, shunt rates are around 6%; however, false positives are approximately 1%, and negatives are up to 40.6%. 5 Due to the complexities and inaccuracies of these techniques, when performing CEA under GA, the surgical community is divided into the majority routine-shunters and minority selective-shunters, the latter of which may use any of the above techniques with a clinical assessment of strong pulsatile backbleeding.…”

mentioning

confidence: 99%

See 1 more Smart Citation