Stump pressure, electroencephalographic changes, and the contralateral carotid artery: Another look at selective shunting

Harada, Russell N.; Comerota, Anthony J.; Good, Garth M.; Hashemi, Homayoun A.; Hulihan, Joseph

doi:10.1016/s0002-9610(99)80275-x

Cited by 70 publications

(35 citation statements)

References 17 publications

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“…We found cerebral ischemia during clamping in 16% of patients with an ICA stenosis only and in 42% of patients with an ICA stenosis and a contralateral ICA occlusion. Although these proportions are in good accordance with a number of previous studies, 5,6,43,44 other studies found higher proportions, ranging from 25% to 38% in patients with an ICA stenosis only and from 59% to 71% in patients with an ICA stenosis and a contralateral ICA occlusion. 3,4,7 It is hard to explain these discrepancies, but there may have been differences in composition of study groups, methodology of EEG monitoring, or interpretation of EEG results.…”

Section: Rutgers Et Al Preoperative Mra Volume Flow In Cea Patientssupporting

confidence: 91%

“…We performed separate analyses for these patient groups because the presence of an occlusion of the contralateral ICA is thought to be associated with a higher risk of ischemic EEG changes during clamping of the carotid artery. [3][4][5][6] The carotid arteries were investigated with intra-arterial digital subtraction angiography in 77 patients, according to the criteria of the North American Symptomatic Carotid Endarterectomy Trial (NASCET). 10 In 9 patients, the carotid arteries were investigated with Doppler ultrasonography.…”

Section: Patients and Control Subjectsmentioning

confidence: 99%

“…In CEA procedures, patients are often monitored with electroencephalography (EEG) to assess whether cerebral ischemia develops during the necessary cross-clamping of the carotid artery. [1][2][3][4][5][6][7] The development of ischemic EEG changes likely indicates cerebral hypoperfusion. 1,8,9 Preoperative evaluation of flow in the carotid artery that is clamped and of cerebropetal flow in other arteries such as the contralateral carotid artery and the basilar artery (BA) can add to the understanding of pathophysiological differences between patients who develop ischemic EEG changes during clamping and patients who do not.…”

mentioning

confidence: 99%

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Preoperative MRA Flow Quantification in CEA Patients

Rutgers

Blankensteijn

Grond

2000

Stroke

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Section: Rutgers Et Al Preoperative Mra Volume Flow In Cea Patientssupporting

confidence: 91%

Section: Patients and Control Subjectsmentioning

confidence: 99%

mentioning

confidence: 99%

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Preoperative MRA Flow Quantification in CEA Patients

Rutgers

Blankensteijn

Grond

2000

Stroke

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“…More recently, studies have suggested that monitoring and selective shunt use during CEA decreases the risk of perioperative stroke and can be superior to routine shunt placement. 5,6 Electroencephalography (EEG) is a sensitive indicator of cerebral ischemia, [7][8][9] and CEA performed with routine EEG monitoring and selective shunt placement is safe and effective. [10][11][12][13] The aim of this study was to examine the clinical and anatomic factors associated with significant EEG changes that required shunt placement in CEA performed with routine EEG monitoring.…”

mentioning

confidence: 99%

Predictors of shunt during carotid endarterectomy with routine electroencephalography monitoring

Tan

Garcia-Toca

Marcaccio

et al. 2009

Journal of Vascular Surgery

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CEA performed with routine EEG monitoring and selective shunt placement is associated with a low risk of perioperative stroke. Identified predictors of significant EEG changes were anatomic factors including degree of contralateral carotid artery disease and moderate ipsilateral carotid artery stenosis (50% to 79%). Although contralateral carotid occlusion has been accepted as indication for shunt placement in the absence of cerebral monitoring, this study suggests that high-grade contralateral disease and moderate ipsilateral carotid stenosis are associated with cerebral ischemia resulting in EEG changes and should prompt consideration for nonselective shunting.

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“…There are disadvantages such as particle embolization associated with carotid shunt use [26]. We used shunt in all of our patients in our clinic.…”

Section: Intraoperative Data Numbermentioning

confidence: 99%

A New Approach to Myocardial Revascularization in Patients with Severe Carotid Lesions: Simultaneous Cardiopulmonary Bypass and Local Carotid Endarterectomy

Teker¹

2017

J Cardiovasc Dis Diagn

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Aim: In the present study, we aimed to present the retrospective outcomes of the patients who underwent carotid endarterectomy under local anesthesia followed by cardiopulmonary bypass under general anesthesia during the same session.Material and methods: 52 patients (36 male, 16 female patients; mean age was 69.0 ± 8.5 years: range 42 to 75 years) with carotid lesions underwent carotid endarterectomy under local anesthesia and simultaneous cardiopulmonary bypass between 1 st March 2015 and 1 st March 2016 in our center. This study involved patients with myocardial revascularization and 80% or more carotid stenosis (with or without contralateral disease). Preoperative, preoperative and postoperative characteristics of the patients were retrospectively analyzed.Results: Operative mortality rate was 1.9% with one patient. Early postoperative revision was performed in 3 patients (5.7%) bleeding. Postoperative atrial fibrillation developed in 6 patients (11.5%). There was no cerebrovasculary accident postoperatively. Conclusion:The incidence of coronary and carotid artery disease coexistence is not too low. The combined approach increases the stroke and mortality rate by using general anesthesia in the procedure, although the odds of complications appearing to reduce the duration of hospitalization with the performance of a single seansta procedure. In this study, we reported that local carotid artery intervention and simultaneous coronary artery bypass surgery reduced the stroke risk and mortality rates.

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Stump pressure, electroencephalographic changes, and the contralateral carotid artery: Another look at selective shunting

Cited by 70 publications

References 17 publications

Preoperative MRA Flow Quantification in CEA Patients

Preoperative MRA Flow Quantification in CEA Patients

Predictors of shunt during carotid endarterectomy with routine electroencephalography monitoring

A New Approach to Myocardial Revascularization in Patients with Severe Carotid Lesions: Simultaneous Cardiopulmonary Bypass and Local Carotid Endarterectomy

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