| Predictors of electroencephalographic changes needing shunting during carotid endarterectomy. | |
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MedLine Citation:
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PMID: 21035696 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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BACKGROUND: Carotid endarterectomy (CEA) is associated with a risk of cerebral ischemia during carotid clamping, hence various cerebral protection strategies, including pharmacological management and routine or selective shunting, are commonly available. This study aimed to analyze the results of CEA with intraoperative electroencephalographic (EEG) monitoring to identify factors associated with EEG changes consistent with cerebral ischemia which needed shunting. METHODS: A prospectively compiled, computerized database of all primary CEAs performed at our institution with EEG monitoring for symptomatic or asymptomatic severe carotid lesions between January 1990 and June 2009 was analyzed. RESULTS: In all, 1,914 CEA procedures were performed on 1,696 patients, of which 218 had staged bilateral CEAs. EEG changes were recorded in 392 patients (20.5%), but a shunt was inserted during 312 CEA procedures (16.3%). Multivariate analysis showed that a symptomatic presentation (odds ratio [OR], 1.37; 95% confidence intervals [CI], 1.07-1.76; p = 0.012), prior stroke (OR, 2.28; 95% CI, 1.66-3.13; p < 0.001), contralateral carotid occlusion (OR, 2.14; 95% CI, 1.18-3.91; p = 0.019), and moderate (<80%) ipsilateral carotid disease (OR, 1.95; 95% CI, 1.08-3.52; p = 0.033) predicted the need for shunting. CONCLUSIONS: EEG was an excellent detector of cerebral ischemia and a valuable tool in guiding the need for shunting. Patients who were symptomatic or had a history of stroke, a contralateral carotid occlusion, or an ipsilateral moderate carotid stenosis were more prone to EEG changes consistent with cerebral ischemia. Surgeons should consider EEG changes during clamping as an effective criterion for selective shunting. |
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Authors:
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Enzo Ballotta; Marina Saladini; Mario Gruppo; Franco Mazzalai; Giuseppe Da Giau; Claudio Baracchini |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Annals of vascular surgery Volume: 24 ISSN: 1615-5947 ISO Abbreviation: Ann Vasc Surg Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-11-01 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8703941 Medline TA: Ann Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1045-52 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Vascular Surgery Section, Geriatric Surgery Clinic, Department of Surgical and Gastroenterological Sciences, School of Medicine, University of Padua, Padua, Italy. enzo.ballotta@unipd.it |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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