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Selective internal carotid artery cross-clamping increases the specificity of cerebral oximetry for indication of shunting during carotid endarterectomy
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SYSNO ASEP 0538550 Document Type J - Journal Article R&D Document Type Journal Article Subsidiary J Článek ve WOS Title Selective internal carotid artery cross-clamping increases the specificity of cerebral oximetry for indication of shunting during carotid endarterectomy Author(s) Hejčl, Aleš (UEM-P) RID, ORCID
Jiránková, K. (CZ)
Malucelli, A. (CZ)
Sejkorová, A. (CZ)
Radovnický, T. (CZ)
Bartoš, T. (CZ)
Orlický, M. (CZ)
Brušáková, Š. (CZ)
Hrach, K. (CZ)
Kastnerová, J. (CZ)
Sameš, M. (CZ)Source Title Acta Neurochirurgica. - : Springer - ISSN 0001-6268
Roč. 163, č. 6 (2021), s. 1807-1817Number of pages 11 s. Language eng - English Country AT - Austria Keywords carotid endarterectomy ; neuromonitoring ; stroke Subject RIV FH - Neurology OECD category Neurosciences (including psychophysiology Method of publishing Limited access Institutional support UEM-P - RVO:68378041 UT WOS 000583924000001 EID SCOPUS 85094148772 DOI 10.1007/s00701-020-04621-1 Annotation Background An indication for selective shunting during carotid endarterectomy (CEA) is based on monitoring during a procedure. Cerebral oximetry (CO) using near-infrared spectroscopy (NIRS) may be a simple technique, but its relevance during CEA, especially with respect to cutoff values indicating shunt implantation, still needs to be elucidated. Methods One hundred twenty five patients underwent CEA under local anesthesia (LA) and were monitored clinically throughout the whole procedure. The patients were also monitored using bilateral NIRS probes during surgery. The NIRS values were recorded and evaluated before and after selective cross-clamping, firstly by the external carotid artery (ECA), followed by the internal carotid artery (ICA). The decrease in the ipsilateral CO values, with respect to the indication of shunting, was only analyzed after selective cross-clamping of the ICA. The decision to use an intraluminal shunt was solely based on the neurological status evaluation after ICA cross-clamping. Results One hundred five patients (85%) were stable throughout the CEA, while 20 patients (15%) clinically deteriorated during surgery. The mean drop in the CO after selective ICA clamping in clinically stable patients was 6%, while in patients with clinical deterioration, the NIRS decreased by 14.5% (p < 0.05). When the cutoff value for selective shunting was set as a 10% decrease of the ipsilateral CO after selective ICA clamping, the sensitivity of the technique was 100% and the specificity 83.0%. Conclusions Our study showed that a 10% decrease in the ipsilateral brain tissue oximetry after selective cross-clamping the ICA provides a reliable cutoff value for selective shunting during CEA. Despite the availability of a variety of monitoring tools, the NIRS may be an easy, reliable option, especially in the scenario of acute CEA in general anesthesia. Workplace Institute of Experimental Medicine Contact Lenka Koželská, lenka.kozelska@iem.cas.cz, Tel.: 241 062 218, 296 442 218 Year of Publishing 2023 Electronic address https://link.springer.com/article/10.1007/s00701-020-04621-1
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