Korean J Thorac Cardiovasc Surg.  2017 Dec;50(6):448-452. 10.5090/kjtcs.2017.50.6.448.

Near-Infrared Spectroscopy versus Transcranial Doppler-Based Monitoring in Carotid Endarterectomy

• Cho JW
• Jang JS

• KMID: 2398376
• DOI: http://doi.org/10.5090/kjtcs.2017.50.6.448

Abstract

BACKGROUND
Proper monitoring of cerebral perfusion during carotid artery surgery is crucial for determining if a shunt is needed. We compared the safety and reliability of near-infrared spectroscopy (NIRS) with transcranial Doppler (TCD) for cerebral monitoring.
METHODS
This single-center, retrospective review was conducted on patients who underwent carotid endarterectomy (CEA) using selective shunt-based TCD or NIRS at Daegu Catholic University Medical Center from November 2009 to June 2016. Postoperative complications were the primary outcome, and the distribution of risk factors between the 2 groups was compared.
RESULTS
The medical records of 74 patients (45 TCD, 29 NIRS) were reviewed. The demographic characteristics were similar between the 2 groups. One TCD patient died within the 30-day postoperative period. Postoperative stroke (n=4, p=0.15) and neurologic complications (n=10, p=0.005) were only reported in the TCD group. Shunt usage was 44.4% and 10.3% in the TCD and NIRS groups, respectively (p=0.002).
CONCLUSION
NIRS-based selective shunting during CEA seems to be safe and reliable for monitoring cerebral perfusion in terms of postoperative stroke and neurologic symptoms. It also reduces unnecessary shunt usage.

Keyword

Carotid endarterectomy; Near-infrared spectroscopy; Stroke

MeSH Terms

Academic Medical Centers
Carotid Arteries
Daegu
Endarterectomy, Carotid*
Humans
Medical Records
Neurologic Manifestations
Perfusion
Postoperative Complications
Postoperative Period
Retrospective Studies
Risk Factors
Spectroscopy, Near-Infrared*
Stroke