The Efficacy of Near-Infrared Spectroscopy Monitoring in Carotid Endarterectomy: A Prospective, Single-Center, Observational Study

Wang, Yu; Li, Li; Wang, Tianlong; Zhao, Lei; Han, Feng; Wang, Qian; Li, Fan; Feng, Xia; Xiao, Wei; Feng, Kunpeng

doi:10.1177/0963689718817760

Cited by 28 publications

(19 citation statements)

References 34 publications

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“…Twenty percent or more reduction in rSO 2 during ICA clamping is associated with a 10-fold increase in ischemic stroke [14]. The values measured with NIRS are consistent with transcranial doppler and a 12.3% reduction from baseline in rSO 2 can be used as a reliable threshold for intraoperative cerebral perfusion [15]. Moreover, it aids in avoiding carotid artery manipulation by reducing unnecessary use of shunts which may result in dissection or embolism [16].…”

Section: Discussionmentioning

confidence: 58%

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Safe carotid endarterectomy: “one fits all strategy”

Ünlü¹,

Durukan²

2020

kitp

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Introduction: Carotid artery stenosis of 50% or more in the extracranial internal carotid artery is responsible for 10-15% of all strokes. Interventional treatment options include carotid endarterectomy and carotid artery stenting, where endarterectomy is proven to be superior. Aim: In this study, we report the carotid endarterectomy results of patients we operated on using the strategy we termed the "one fits all strategy". Material and methods: Seventy-six patients undergoing carotid endarterectomy between July 2016 and April 2020 were retrospectively studied. Conventional endarterectomy under general anesthesia with primary closure of the arteriotomy was performed in all patients. We used a near infrared spectroscopy oximeter to measure regional cerebral oxygenation continuously throughout the surgery. Results: The mean age of the patients was 70.96 8.15 years. There were 52 male and 24 female patients. The mean followup time was 20.6 ±13.6 months. Coronary artery disease was detected in 52 (73.6%) patients. Coronary artery bypass operation was indicated in 19 patients in whom a staged approach was performed in 13 and a reverse staged approach in 1. There were two perioperative strokes one of which recovered fully spontaneously and the other partially with physiotherapy. Eight cases were revised due to hematoma formation. Conclusions: Carotid endarterectomy continues to prove its safety in carotid artery stenosis patients. Continuous cerebral oxygenation monitoring is indispensable for carotid surgery. Despite discrepancies in surgical techniques, we believe that "one fits all strategy: general anesthesia, conventional endarterectomy without patch plasty, never shunter and always NIRS monitorization" may be used safely in patients undergoing carotid endarterectomy.

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Section: Discussionmentioning

confidence: 58%

“…The mean age of the patients was 70.96 ±8. 15 ORIGINAL PAPER patients had a neurological sequela due to stroke preoperatively. Coronary artery disease was detected in 56 (73.6%) patients.…”

Section: Resultsmentioning

confidence: 99%

Safe carotid endarterectomy: “one fits all strategy”

Ünlü¹,

Durukan²

2020

kitp

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“…Yu Wang et al (12) found that the sensitivity and specificity of NIRS monitoring for intraoperative hypoperfusion were 64.3% and 90.0%, resulting in a strong consistency with TCD monitoring results. JM Findlay et al ( 13) compared stump pressures and NIRS measurements in CEA operations in terms of shunt placement and reported that NIRS was more accurate than stump pressure measurement.…”

Section: Discussionmentioning

confidence: 88%

The effect of normotensive arterial pressure on cerebral saturation during carotid endarterectomy

Yücel¹,

Kayalar²

2021

Journal of Health Sciences and Medicine

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Aim: Monitoring of cerebral perfusion during carotid endarterectomy helps to institute early intervention to prevent risk of ischemia during the operation. We aimed to evaluate if the disadvantages of high systemic pressure can be avoided by keeping arterial blood pressure below 150 mmHg during cross-clamping of the internal carotid artery by correlating our findings of NIRS values with clinical results. Material and Method: This was designed as a prospective study that included elective patients scheduled for an operation of carotid artery stenosis under general anesthesia. A total of 60 patients operated on between August and October 2019 were included in the study. Results: Patients' NIRS findings on the right and left hemispheres were analyzed separately to be able to differentiate any possible changes of NIRS of the cerebral hemisphere ipsilateral to the clamped carotid artery. The analysis of the right and left NIRS findings in these 60 patients revealed a significant decrease between intubation and incision NIRS values (p=0.008 and p=0.02 respectively). Conclusion:Considering the NIRS findings and clinical observations of the patients in the postoperative period, we think that ICA endarterectomy operations may be safe to perform in a suitable patient group while the systolic arterial blood pressure is maintained below 150mmHg during cross-clamping.

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“…Pedrini et al also used a 20 % decrease as a cut-off value for the shunt insertion; they reported no postoperative stroke or death. Wang with coworkers in 2019, compared TCD and TCO in 84 patients undergoing carotid endarterectomy in general anesthesia, the false-positive results and positive were worse, but they used 12.5 % decrease as a cut-off value for inserting (21). However, the authors reported no postoperative stroke or death in their cohort.…”

Section: Discussionmentioning

confidence: 99%

Cerebral monitoring during carotid endarterectomy using transcranial cerebral oximetry

Sihotský¹,

Berek²,

Kopolovets³

et al. 2020

BLL

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OBJECTIVE: This study aimed to evaluate the outcomes of carotid endarterectomies (CEA) performed using transcranial cerebral oximetry as cerebral monitoring METHODS: This single-center study included patients treated surgically for signifi cant stenosis of the internal carotid artery (ICA) from January 2012 to December 2017 RESULTS: Of the 654 patients, 267 were asymptomatic, and 387 were symptomatic. Eversion CEA was performed in 64.8 %, and patched conventional CEA in 35.2 % of all patients. Totally 11.4 % of all patients had a shunt inserted; all patients with the inserted shunt had the conventional pathed CEA. Severe postoperative complications occurred in 1.5 % of asymptomatic patients and 2.6 % of symptomatic patients. The stroke and death ratio in the shunted group was 2.7 %, and in the non-shunted group, 2.1 % (p = 0.7). We found no signifi cant difference in severe postoperative complications between the shunted and non-shunted group. Further, we found the male gender (p = 0.005), coronary artery disease (p = 0.01), and ongoing smoking (p = 0.003) to be signifi cantly associated with neurological symptoms of the ICA stenosis. We also confi rmed current tobacco smoking to be signifi cantly associated with the occurrence of postoperative stroke and death (p = 0.005) CONCLUSION: We found transcranial cerebral oximetry to be reliable in the determination of shunt insertion

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The Efficacy of Near-Infrared Spectroscopy Monitoring in Carotid Endarterectomy: A Prospective, Single-Center, Observational Study

Cited by 28 publications

References 34 publications

Safe carotid endarterectomy: “one fits all strategy”

Safe carotid endarterectomy: “one fits all strategy”

The effect of normotensive arterial pressure on cerebral saturation during carotid endarterectomy

Cerebral monitoring during carotid endarterectomy using transcranial cerebral oximetry

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