Korean J Thorac Cardiovasc Surg.  2016 Feb;49(1):22-28. 10.5090/kjtcs.2016.49.1.22.

Selective Carotid Shunting Based on Intraoperative Transcranial Doppler Imaging during Carotid Endarterectomy: A Retrospective Single-Center Review

• Cho JW
• Jeon YH
• Bae CH

• KMID: 2154332
• DOI: http://doi.org/10.5090/kjtcs.2016.49.1.22

Abstract

BACKGROUND
Carotid endarterectomy (CEA) with selective shunting is the surgical method currently used to treat patients with carotid artery disease. We evaluated the incidence of major postoperative complications in patients who underwent CEA with selective shunting under transcranial Doppler (TCD) at our institution.
METHODS
The records of 45 patients who underwent CEA with TCD-based selective shunting under general anesthesia from November 2009 to June 2015 were reviewed. The risk factors for postoperative complications were analyzed using univariate and multivariate analysis.
RESULTS
Preoperative atrial fibrillation was observed in three patients. Plaque ulceration was detected in 10 patients (22.2%) by preoperative computed tomography imaging. High-level stenosis was observed in 16 patients (35.5%), and 18 patients had contralateral stenosis. Twenty patients (44.4%) required shunt placement due to reduced TCD flow or a poor temporal window. The 30-day mortality rate was 2.2%. No cases of major stroke were observed in the 30 days after surgery, but four cases of minor stroke were noted. Univariate analysis showed that preoperative atrial fibrillation (odds ratio [OR], 40; p=0.018) and ex-smoker status (OR, 17.5; p=0.021) were statistically significant risk factors for a minor stroke in the 30-day postoperative period. Analogously, multivariate analysis also found that atrial fibrillation (p<0.001) and ex-smoker status (p=0.002) were significant risk factors for a minor stroke in the 30-day postoperative period. No variables were identified as risk factors for 30-day major stroke or death. No wound complications were found, although one (2.2%) of the patients suffered from a hypoglossal nerve injury.
CONCLUSION
TCD-based CEA is a safe and reliable method to treat patients with carotid artery disease. Preoperative atrial fibrillation and ex-smoker status were found to increase the postoperative risk of a small embolism leading to a minor neurologic deficit.

Keyword

Carotid endarterectomy; Transcranial Doppler ultrasonography; Selective shunt

MeSH Terms

Anesthesia, General
Atrial Fibrillation
Carotid Artery Diseases
Constriction, Pathologic
Embolism
Endarterectomy, Carotid*
Humans
Hypoglossal Nerve Injuries
Incidence
Mortality
Multivariate Analysis
Neurologic Manifestations
Postoperative Complications
Postoperative Period
Retrospective Studies*
Risk Factors
Stroke
Ulcer
Ultrasonography, Doppler, Transcranial
Wounds and Injuries