Document Detail


Risks and benefits of shunting in carotid endarterectomy. The International Transcranial Doppler Collaborators.
MedLine Citation:
PMID:  1440706     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Controversy continues about the pathogenesis of perioperative stroke in carotid endarterectomy and the use of shunting. The purpose of this study was to determine, using transcranial Doppler ultrasonography, the severity of ischemia during clamping of the carotid artery as a basis for analysis of complications in patients operated on with and without shunting. METHODS: In a retrospective study, 11 centers contributed 1,495 carotid endarterectomies monitored with transcranial Doppler. The cases were divided into groups with severe, mild, and no ischemia, and each group was subdivided according to shunt use. The perioperative rate of severe stroke attributable to intraoperative ischemia, in addition to total perioperative stroke, was determined for each subgroup. RESULTS: Severe ischemia occurred in 7.2% of our cases but cleared spontaneously in about half of these. In those with persisting ischemia the rate of severe stroke was very high, while shunting protected against stroke in such cases. If ischemia did not occur, the stroke rate was higher with shunting, although not so high as in unshunted cases with severe ischemia. Slightly more than one third of the severe strokes were due to postoperative cerebral hemorrhage or carotid thrombosis, unrelated to clamp-induced ischemia or shunting. CONCLUSIONS: Carotid endarterectomy complications might be reduced by selectively shunting only for severe persisting ischemia. Monitoring of cerebral ischemia would be essential to selective shunting.
Authors:
J H Halsey
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  23     ISSN:  0039-2499     ISO Abbreviation:  Stroke     Publication Date:  1992 Nov 
Date Detail:
Created Date:  1992-12-01     Completed Date:  1992-12-01     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1583-7     Citation Subset:  IM    
Affiliation:
Neurologic Institute, New York, NY 10032-2603.
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MeSH Terms
Descriptor/Qualifier:
Brain Ischemia / surgery,  ultrasonography
Carotid Arteries / surgery*
Cerebrovascular Disorders / etiology
Endarterectomy / adverse effects,  methods*
Evaluation Studies as Topic
Humans
Monitoring, Physiologic
Postoperative Complications / prevention & control*
Retrospective Studies
Risk Factors
Comments/Corrections
Comment In:
Stroke. 1993 Jul;24(7):1098-9   [PMID:  8322390 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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