Near-infrared Spectroscopy to Indicate Selective Shunt Use During Carotid Endarterectomy

Objectives This study assessed the value of cerebral near-infrared spectroscopy (NIRS) and transcranial Doppler (TCD) in relation to electroencephalography (EEG) changes for the detection of cerebral hypoperfusion necessitating shunt placement during carotid endarterectomy (CEA). Methods This was a...

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Bibliographic Details
Published in:European journal of vascular and endovascular surgery 2013-10, Vol.46 (4), p.397-403
Main Authors: Pennekamp, C.W.A, Immink, R.V, den Ruijter, H.M, Kappelle, L.J, Bots, M.L, Buhre, W.F, Moll, F.L, de Borst, G.J
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anesthesia, General
Biomarkers - blood
Blood Flow Velocity
Brain Ischemia - blood
Brain Ischemia - diagnosis
Brain Ischemia - etiology
Brain Ischemia - physiopathology
Brain Ischemia - surgery
Carotid endarterectomy
Carotid Stenosis - diagnosis
Carotid Stenosis - physiopathology
Carotid Stenosis - surgery
Cerebrovascular Circulation
Complications of carotid endarterectomy
Constriction
Electroencephalography
Endarterectomy, Carotid - adverse effects
Female
Humans
Male
Middle Aged
Monitoring, Intraoperative - methods
Near-infrared spectroscopy
Oxygen - blood
Predictive Value of Tests
Prospective Studies
Regional Blood Flow
ROC Curve
Selective shunt placement
Spectroscopy, Near-Infrared
Surgery
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Transcranial
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Summary:Objectives This study assessed the value of cerebral near-infrared spectroscopy (NIRS) and transcranial Doppler (TCD) in relation to electroencephalography (EEG) changes for the detection of cerebral hypoperfusion necessitating shunt placement during carotid endarterectomy (CEA). Methods This was a prospective cohort study. Patients with a sufficient TCD window undergoing CEA from February 2009 to June 2011 were included. All patients were continuously monitored with NIRS and EEG. An intraluminal shunt was placed, selectively determined by predefined EEG changes in alpha, beta, theta, or delta activity. Relative changes in regional cerebral oxygen saturation (rSO2 ) in the frontal lobe and mean blood flow velocity ( Vmean ) 30 seconds before carotid cross-clamping versus 2 minutes after carotid cross-clamping were related to shunt placement. Receiver operating characteristic curve analysis was performed to determine the optimal thresholds. Diagnostic values were reported as positive and negative predictive value (PPV and NPV). Results Of a cohort of 151 patients, 17(11%) showed EEG changes requiring shunt placement. The rSO2 and Vmean decreased more in the shunt group than in the non-shunt group (mean ± standard error of the mean) 21 ± 4% versus 7 ± 5% and 76 ± 6% versus 12 ± 3%, respectively ( p  
ISSN:1078-5884
1532-2165
DOI:10.1016/j.ejvs.2013.07.007