Document Detail

Carotid endarterectomy without shunt: the role of cerebral metabolic protection.
MedLine Citation:
PMID:  16354546     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The optimal method to protect the brain from hemodynamic ischemia during carotid endarterectomy (CEA) remains controversial. This study reports our experience with induced arterial hypertension and selective etomidate cerebral protection in a cohort of patients who underwent CEA without shunting and continuous electroencephalography (EEG) monitoring. METHODS: We reviewed retrospectively 102 consecutive CEAs performed in 102 patients with routine EEG monitoring and general anesthesia between March 1998 and October 2002. There were 65 (66%) symptomatic and 37 (34%) asymptomatic individuals. A protocol of induced arterial hypertension against EEG ischemic changes during carotid artery cross clamping was followed. Only patients with EEG changes refractory to induced hypertension went into etomidate-induced burst suppression. RESULTS: EEG changes were classified as mild, moderate and severe. Twenty patients (19.6%) developed asymmetric EEG changes, of which the great majority were mild and moderate (75%, p< 0.05). Seven patients with moderate (n=3) and severe (n=4) EEG changes needed etomidate cerebral protection. There were no mortalities and only one stroke (0.98%) is reported in the series. The morbidity rate was 6.8% and included transient cranial nerve palsies (n=5) and wound hematoma (n=1). CONCLUSIONS: Carotid endarterectomy can be safely performed with EEG monitoring and selective induced arterial hypertension and etomidate cerebral protection. Our results suggest that this method may be a good alternative for shunting and its inherent risks.
Miguel A Melgar; Nitin Mariwalla; Hassan Madhusudan; Martin Weinand
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Neurological research     Volume:  27     ISSN:  0161-6412     ISO Abbreviation:  Neurol. Res.     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-15     Completed Date:  2006-03-29     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7905298     Medline TA:  Neurol Res     Country:  England    
Other Details:
Languages:  eng     Pagination:  850-6     Citation Subset:  IM    
Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
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MeSH Terms
Aged, 80 and over
Anesthetics, Intravenous / administration & dosage,  therapeutic use*
Anticoagulants / therapeutic use
Blood Pressure
Carotid Stenosis / complications,  surgery*,  ultrasonography
Cohort Studies
Endarterectomy, Carotid / methods*
Etomidate / administration & dosage,  therapeutic use*
Follow-Up Studies
Heparin / therapeutic use
Intracranial Embolism / etiology,  prevention & control*
Intraoperative Period
Middle Aged
Monitoring, Intraoperative
Myocardial Ischemia / complications
Neuroprotective Agents / administration & dosage,  therapeutic use*
Retrospective Studies
Risk Factors
Treatment Outcome
Reg. No./Substance:
0/Anesthetics, Intravenous; 0/Anticoagulants; 0/Neuroprotective Agents; 33125-97-2/Etomidate; 9005-49-6/Heparin

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