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A systematic review & meta-analysis on perioperative cerebral and hemodynamic monitoring methods during carotid endarterectomy

Published:September 09, 2022DOI:https://doi.org/10.1016/j.avsg.2022.08.015

      Abstract

      Objective

      To compare outcomes between different strategies of perioperative cerebral and hemodynamic monitoring during carotid endarterectomy.

      Data sources

      MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL databases were searched.

      Methods

      This review was performed according to the PRISMA guidelines and prospectively registered in the international prospective register of systematic reviews (CRD42021241891). The GRADE approach was used to describe the methodological quality of the studies and certainty of the evidence. The primary outcome was 30-day stroke rate. Secondary outcomes measures are 30-day ipsilateral stroke, 30-day mortality, shunt rate and complication rates.

      Results

      The search identified 3 460 articles. Seventeen RCTs, three prospective observational studies and seven registries were included, reporting on 236 983 patients. The overall pooled 30-day stroke rate is 1.8% (95% CI 1.4 – 2.2%), ranging from 0 - 12.6%. In RCT’s the pooled 30-day stroke rate is 2.7% (95% CI 1.6 – 3.7%) compared to 1.3% (95%CI 0.8 – 1.8%) in the registries. The overall stroke risk decreased from 3.7% before the year 2000 to 1.6% after 2000. No significant differences could be identified between different monitoring and shunting strategies, although a trend to higher stroke rates in routine no shunting arms of RCTs was observed. Overall 30-day mortality, myocardial infarction and nerve injury rates are 0.6% (95%CI 0.4 – 0.8), 0.8% (95%CI 0.6-1.0) and 1.3% (95%CI 0.4-2.2), respectively.

      Conclusions

      No significant differences between the compared shunting and monitoring strategies are found. However, routine no shunting is not recommended. The available data is too limited to prefer one method of neuromonitoring over another method when selective shunting is applied.

      Keywords

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