Document Detail


Hemodynamic cerebral ischemia during carotid endarterectomy evaluated by intraoperative monitoring and post-operative diffusion-weighted imaging.
MedLine Citation:
PMID:  17427279     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We used the result of monitoring to evaluate patients with post-operative neurological deficits attributable to hemodynamic cerebral ischemia owing to cross-clamping of the carotid artery. METHODS: We evaluated 131 carotid endarterectomy (CEA) procedures performed on 118 patients, 96 men and 22 women ranging in age from 38 to 82 years (mean: 67.1 years). For monitoring, we used a combination of somatosensory evoked potential (SEP), functional dynamic electroencephalography (EEG), near-infrared spectroscopy (NIRS) and transcranial Doppler (TCD). Patients who awoke with neurological deficits after CEA immediately underwent diffusion-weighted imaging (DWI) and magnetic resonance angiography (MRA). RESULTS: In 30 of the 131 procedures (22.9%), intraoperative monitoring disclosed abnormalities after cross-clamping of the internal carotid artery (ICA). In two of these 30 patients, shunt was not introduced, because of full recovery of monitoring after blood pressure increasing, however, one patient demonstrated transient ischemic attack (TIA). In six of remaining 28 patients who need shunt, transient hemodynamic cerebral ischemia occurred, however, all patients recovered gradually within 18 hours after CEA. No new lesions were detected on post-operative DWI of the seven patients and MRA demonstrated good patency of the carotid artery. The other 101 patients whose intraoperative monitoring after cross-clamping of the ICA did not disclose abnormalities demonstrated no hemodynamic TIA. CONCLUSION: Hemodynamic ischemia owing to cross-clamping of the ICA is rare in patients treated by CEA. However, in patients manifesting neurological deficits upon awakening from CEA, DWI and MRA should be performed immediately to facilitate their prompt treatment.
Authors:
Masaaki Uno; Atsuhiko Suzue; Kyoko Nishi; Shinji Nagahiro
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurological research     Volume:  29     ISSN:  0161-6412     ISO Abbreviation:  Neurol. Res.     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2007-04-11     Completed Date:  2007-05-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7905298     Medline TA:  Neurol Res     Country:  England    
Other Details:
Languages:  eng     Pagination:  70-7     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Faculty of Medicine, the University of Tokushima, Tokushima, Japan. muno@clin.med.tokushima-u.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Aged
Brain Ischemia / diagnosis*,  etiology,  physiopathology
Carotid Artery, Internal / physiopathology,  surgery
Cerebral Arteries / pathology,  physiopathology
Cerebrovascular Circulation / physiology
Diffusion Magnetic Resonance Imaging / methods*,  standards
Early Diagnosis
Electroencephalography / methods
Endarterectomy, Carotid / adverse effects*
Evoked Potentials, Somatosensory / physiology
Female
Humans
Male
Middle Aged
Monitoring, Intraoperative / methods*
Postoperative Complications / diagnosis*,  etiology,  physiopathology
Predictive Value of Tests
Recovery of Function
Spectroscopy, Near-Infrared / methods
Ultrasonography, Doppler, Transcranial / methods

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