Cerebral oximetry and stump pressure as indicators for shunting during carotid endarterectomy: Comparative evaluation

Charalambos L. Tambakis; George Papadopoulos; Theodoros N. Sergentanis; Nikolaos Lagos; Eleni Arnaoutoglou; Nicos Labropoulos; Miltiadis I. Matsagkas

doi:10.1258/vasc.2010.oa0277

Cerebral oximetry and stump pressure as indicators for shunting during carotid endarterectomy: Comparative evaluation

Charalambos L. Tambakis
, George Papadopoulos
, Theodoros N. Sergentanis
, Nikolaos Lagos
, Eleni Arnaoutoglou
, Nicos Labropoulos
, Miltiadis I. Matsagkas

Surgery

University of Ioannina
National and Kapodistrian University of Athens

Research output: Contribution to journal › Article › peer-review

19 Scopus citations

Abstract

The purpose of this work is to investigate the correlation between regional oxygen saturation (rSO ₂) changes and stump pressure (SP) during cross-clamping of the internal carotid artery in carotid endarterectomy (CEA) and verify the perspectives of rSO ₂ to become a criterion for shunting. Sixty consecutive CEAs under general anesthesia were studied prospectively. Selective shunting was based on SP ≤40 mmHg exclusively. Regression analysis with high order terms and receiver operating characteristic analysis were performed to investigate the association between ΔrSO ₂(%) and SP and to determine an optimal ΔrSO ₂(%) threshold for shunt insertion. A quadratic association between ΔrSO ₂(%) and SP was documented regarding the baseline to one and five minutes after cross-clamping intervals. A cut-off of 21 and 10.1% reduction from the baseline recording was identified as optimal for the distinction between patients needed or not a shunt regarding the first and fifth minute after cross-clamping, respectively. In conclusion, cerebral oximety reflects sufficiently cerebral oxygenation during CEA compared with SP, providing a useful mean for cerebral monitoring.

Original language	English
Pages (from-to)	187-194
Number of pages	8
Journal	Vascular
Volume	19
Issue number	4
DOIs	https://doi.org/10.1258/vasc.2010.oa0277
State	Published - Aug 2011

Keywords

Carotid endarterectomy
Cerebral monitoring
Cerebral oximetry
Cross-clamping
Neurological impairment
Shunt insertion

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10.1258/vasc.2010.oa0277

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title = "Cerebral oximetry and stump pressure as indicators for shunting during carotid endarterectomy: Comparative evaluation",

abstract = "The purpose of this work is to investigate the correlation between regional oxygen saturation (rSO 2) changes and stump pressure (SP) during cross-clamping of the internal carotid artery in carotid endarterectomy (CEA) and verify the perspectives of rSO 2 to become a criterion for shunting. Sixty consecutive CEAs under general anesthesia were studied prospectively. Selective shunting was based on SP ≤40 mmHg exclusively. Regression analysis with high order terms and receiver operating characteristic analysis were performed to investigate the association between ΔrSO 2(\%) and SP and to determine an optimal ΔrSO 2(\%) threshold for shunt insertion. A quadratic association between ΔrSO 2(\%) and SP was documented regarding the baseline to one and five minutes after cross-clamping intervals. A cut-off of 21 and 10.1\% reduction from the baseline recording was identified as optimal for the distinction between patients needed or not a shunt regarding the first and fifth minute after cross-clamping, respectively. In conclusion, cerebral oximety reflects sufficiently cerebral oxygenation during CEA compared with SP, providing a useful mean for cerebral monitoring.",

keywords = "Carotid endarterectomy, Cerebral monitoring, Cerebral oximetry, Cross-clamping, Neurological impairment, Shunt insertion",

author = "Tambakis, \{Charalambos L.\} and George Papadopoulos and Sergentanis, \{Theodoros N.\} and Nikolaos Lagos and Eleni Arnaoutoglou and Nicos Labropoulos and Matsagkas, \{Miltiadis I.\}",

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AU - Tambakis, Charalambos L.

AU - Papadopoulos, George

AU - Sergentanis, Theodoros N.

AU - Lagos, Nikolaos

AU - Arnaoutoglou, Eleni

AU - Labropoulos, Nicos

AU - Matsagkas, Miltiadis I.

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N2 - The purpose of this work is to investigate the correlation between regional oxygen saturation (rSO 2) changes and stump pressure (SP) during cross-clamping of the internal carotid artery in carotid endarterectomy (CEA) and verify the perspectives of rSO 2 to become a criterion for shunting. Sixty consecutive CEAs under general anesthesia were studied prospectively. Selective shunting was based on SP ≤40 mmHg exclusively. Regression analysis with high order terms and receiver operating characteristic analysis were performed to investigate the association between ΔrSO 2(%) and SP and to determine an optimal ΔrSO 2(%) threshold for shunt insertion. A quadratic association between ΔrSO 2(%) and SP was documented regarding the baseline to one and five minutes after cross-clamping intervals. A cut-off of 21 and 10.1% reduction from the baseline recording was identified as optimal for the distinction between patients needed or not a shunt regarding the first and fifth minute after cross-clamping, respectively. In conclusion, cerebral oximety reflects sufficiently cerebral oxygenation during CEA compared with SP, providing a useful mean for cerebral monitoring.

AB - The purpose of this work is to investigate the correlation between regional oxygen saturation (rSO 2) changes and stump pressure (SP) during cross-clamping of the internal carotid artery in carotid endarterectomy (CEA) and verify the perspectives of rSO 2 to become a criterion for shunting. Sixty consecutive CEAs under general anesthesia were studied prospectively. Selective shunting was based on SP ≤40 mmHg exclusively. Regression analysis with high order terms and receiver operating characteristic analysis were performed to investigate the association between ΔrSO 2(%) and SP and to determine an optimal ΔrSO 2(%) threshold for shunt insertion. A quadratic association between ΔrSO 2(%) and SP was documented regarding the baseline to one and five minutes after cross-clamping intervals. A cut-off of 21 and 10.1% reduction from the baseline recording was identified as optimal for the distinction between patients needed or not a shunt regarding the first and fifth minute after cross-clamping, respectively. In conclusion, cerebral oximety reflects sufficiently cerebral oxygenation during CEA compared with SP, providing a useful mean for cerebral monitoring.

KW - Carotid endarterectomy

KW - Cerebral monitoring

KW - Cerebral oximetry

KW - Cross-clamping

KW - Neurological impairment

KW - Shunt insertion

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AN - SCOPUS:80055085173

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EP - 194

JO - Vascular

JF - Vascular

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ER -

Cerebral oximetry and stump pressure as indicators for shunting during carotid endarterectomy: Comparative evaluation

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Keywords

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