Highlights
- •There is a continuing debate regarding the indications for an intraoperative shunt while performing carotid endarterectomy (CEA). Previous studies have determined these indications based on changes in monitored parameters after cross-clamping reflecting cerebral ischemia. The purpose of our study was to evaluate arterial blood flow (ABF) directly on the carotid artery (direct-ABF) as a potential predictor of cerebral ischemia prior to cross-clamping. The ABF ratio (ABF-internal carotid artery/ABF-common carotid artery) can be a useful predictor of ischemia before cross-clamping.
Abstract
Background
Cross-clamping during carotid endarterectomy (CEA) is associated with the risk of
cerebral ischemia. Various studies have evaluated different criteria for detecting
cerebral ischemia, but difficulties arise when ischemic changes appear after the carotid
artery is cross-clamped and incised. Here, we explored a parameter that can predict
cerebral ischemia prior to cross-clamping during CEA using a blood-flow meter.
Methods
The carotid arterial blood flow was measured directly (direct ABF) in the common carotid
artery prior to cross-clamping. The anatomical information in preoperative magnetic
resonance imaging, cerebral blood flow in xenon-enhanced computed tomography, and
carotid peak systolic flow velocity by carotid echo from the skin surface were also
evaluated. A decrease in the short-latency somatosensory evoked potentials (SSEP)
during cross-clamping to insert a shunt was assessed, and a decrease in amplitude
of ≥ 50% was considered an indicator for cerebral ischemia. Surgery was performed
under general anesthesia, and a shunt was inserted in all cases.
Results
Of 156 CEA patients between April 2013 and March 2020, 30 had decreased SSEP during
cross-clamping. The baseline characteristics and intra- and postoperative findings
were not significantly different between patients with and without a decrease in SSEP.
Among the evaluated parameters, only the direct-ABF ratio (ABF-internal carotid artery/ABF-common
carotid artery) differed significantly between the 2 groups (P = 0.011). The direct-ABF ratio ≤ 0.58 was predictive of cerebral ischemia during
CEA.
Conclusions
Direct-ABF measurement with an ultrasonic blood-flow meter can be useful for predicting
cerebral ischemia prior to carotid artery cross-clamping during CEA.
Keywords
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Article Info
Publication History
Published online: December 22, 2021
Accepted:
November 29,
2021
Received in revised form:
November 18,
2021
Received:
September 8,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.