Vasc Spec Int.  2018 Sep;34(3):72-76. 10.5758/vsi.2018.34.3.72.

Selective Shunting Based on Dual Monitoring with Electroencephalography and Stump Pressure for Carotid Endarterectomy

• Lee J
• Lee S
• Kim SW
• Chang JW

• KMID: 2435438
• DOI: http://doi.org/10.5758/vsi.2018.34.3.72

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).

Keyword

Endarterectomy; Intraoperative neurophysiologic monitoring; Stroke; Carotid artery disease

MeSH Terms

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