Document Detail

Preoperative Magnetic Resonance Angiography as a Predictive Test for Cerebral Ischemia During Carotid Endarterectomy.
MedLine Citation:
PMID:  23212790     Owner:  NLM     Status:  Publisher    
BACKGROUND: To evaluate whether the preoperative magnetic resonance angiography (MRA) can predict the risk of cerebral ischemia associated with the carotid endarterectomy (CEA). METHODS: Between January 2004 and December 2010, 382 consecutive patients (mean age: 56.6 years; range: 45-78 years) were identified to have undergone preoperative MRA and the CEA under regional anesthesia. It was determined that the patient needs shunting during the CEA by intraoperative monitoring of patient's neurology. All patients were divided into two subgroups: shunt group or no-shunt group. Imaging findings on preoperative MRA were correlated to shunting using univariate and multivariate logistic regression analyses combined with patient's demographic and clinical features to identify predictors of cerebral ischemia during the CEA. RESULTS: In 37 of 382 CEA cases (9.7 %), shunting had been performed intraoperatively because the patient had a neurologic deficit. At multivariate analysis, preoperative MRA findings such as the absence of patent communicating arteries (odds ratio [OR], 5.56; 95 % confidence interval [CI], 3.05-9.69; p = 0.013) and the increase of intracranial arteries which were not patent in the contralateral hemisphere (OR, 4.277; 95 % CI, 2.575 to 7.104; p < 0.0001) were significantly associated with shunting. CONCLUSIONS: Preoperative MRA is valuable when predicting cerebral ischemia leading to an inevitable shunting during CEA. Therefore, if there are preoperative MRA findings such as multiple occlusive intracranial arteries in the contralateral hemisphere or the absence of patent communicating arteries, it is recommended that CEA be performed under general anesthesia with routine shunting to avoid a serious shunt-related complication.
Sung Shin; Tae-Won Kwon; Yong-Pil Cho; Ji Hoon Shin; Ann Yi; Hyangkyung Kim; Geun Eun Kim
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-5
Journal Detail:
Title:  World journal of surgery     Volume:  -     ISSN:  1432-2323     ISO Abbreviation:  World J Surg     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, South Korea.
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