Selective Shunting Based on Dual Monitoring with Electroencephalography and Stump Pressure for Carotid Endarterectomy
- Author:
Jonggeun LEE
1
;
Seogjae LEE
;
Su Wan KIM
;
Jee Won CHANG
Author Information
- Publication Type:Original Article
- Keywords: Endarterectomy; Intraoperative neurophysiologic monitoring; Stroke; Carotid artery disease
- MeSH: Anesthesia, General; Carotid Artery Diseases; Carotid Artery, Internal; Carotid Stenosis; Constriction, Pathologic; Electroencephalography; Endarterectomy; Endarterectomy, Carotid; Humans; Intraoperative Neurophysiological Monitoring; Medical Records; Monitoring, Intraoperative; Mortality; Retrospective Studies; Stroke
- From:Vascular Specialist International 2018;34(3):72-76
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: The aim of this study is to analyze postoperative outcomes for carotid endarterectomy (CEA) in addition to the preoperative clinical characteristics related to selective shunting based on dual monitoring with stump pressure (SP) and electroencephalography (EEG). MATERIALS AND METHODS: We retrospectively reviewed medical records of 70 patients who underwent CEA from March 2010 to December 2017. CEA was performed under general anesthesia and selective shunting was done if the SP was lower than 35 mmHg regardless of EEG or if intraoperative EEG showed any changes different from preoperative one regardless of SP. RESULTS: There was no postoperative 30-day adjusted mortality or adverse cardiac events. Three patients (4.3%) had postoperative minor stroke finally reaching pre-operative neurologic status at the time of discharge. Twenty-six patients (37.1%) used shunting and severe contralateral internal carotid stenosis or occlusion was related to shunting (P < 0.010). There were larger number of symptomatic patients in shunt group in spite of no statistical significance (P=0.116). CONCLUSION: Perioperative stroke rate was 4.3% for CEA under general anesthesia based on dual intraoperative monitoring with SP and EEG. There was no 30-day adjusted mortality and adverse cardiac event. Severe stenosis or occlusion of contralateral internal carotid artery is related to shunting (P < 0.010).
