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Selective internal carotid artery cross-clamping increases the specificity of cerebral oximetry for indication of shunting during carotid endarterectomy

The result's identifiers

  • Result code in IS VaVaI

    <a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F68378041%3A_____%2F20%3A00538550" target="_blank" >RIV/68378041:_____/20:00538550 - isvavai.cz</a>

  • Alternative codes found

    RIV/44555601:13450/20:43895602 RIV/00216208:11130/21:10416911 RIV/00159816:_____/21:00075241

  • Result on the web

    <a href="https://link.springer.com/article/10.1007/s00701-020-04621-1" target="_blank" >https://link.springer.com/article/10.1007/s00701-020-04621-1</a>

  • DOI - Digital Object Identifier

    <a href="http://dx.doi.org/10.1007/s00701-020-04621-1" target="_blank" >10.1007/s00701-020-04621-1</a>

Alternative languages

  • Result language

    angličtina

  • Original language name

    Selective internal carotid artery cross-clamping increases the specificity of cerebral oximetry for indication of shunting during carotid endarterectomy

  • Original language description

    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.

  • Czech name

  • Czech description

Classification

  • Type

    J<sub>imp</sub> - Article in a specialist periodical, which is included in the Web of Science database

  • CEP classification

  • OECD FORD branch

    30103 - Neurosciences (including psychophysiology)

Result continuities

  • Project

  • Continuities

    I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Others

  • Publication year

    2020

  • Confidentiality

    S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Data specific for result type

  • Name of the periodical

    Acta Neurochirurgica

  • ISSN

    0001-6268

  • e-ISSN

    0942-0940

  • Volume of the periodical

    163

  • Issue of the periodical within the volume

    6

  • Country of publishing house

    AT - AUSTRIA

  • Number of pages

    11

  • Pages from-to

    1807-1817

  • UT code for WoS article

    000583924000001

  • EID of the result in the Scopus database

    2-s2.0-85094148772