ArticleAnnals of vascular surgery2020
Identifying a Safe Carotid Stump Pressure Threshold for Selective Shunting During Carotid Endarterectomy.
Article in Annals of vascular surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed, 7 citations in OpenAlex.
- Ipsilateral carotid bypass outcomes in hostile neck anatomy.Journal of vascular surgery · 2021Article
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5 authors at 1 institution in 1 country.
Funding
Abstract
backgroundThere is no current consensus on the best criteria for selective shunting during carotid endarterectomy (CEA). The choice of continuous neurologic assessment during awake CEA, intraoperative electroencephalogram, or carotid stump pressure monitoring as the basis for shunt placement is primarily dependent on surgeon preference. Our goal is to define a safe stump pressure threshold as a guide for selective shunting.
methodsThe study is a single-surgeon retrospective review of consecutive patients who underwent CEA under general anesthesia with selective shunting based on intraoperative stump pressure measurements from 2001 to 2019. Demographic and periprocedural variables were analyzed using standard statistical techniques.
resultsAmong 399 patients, 68% were male with a mean age of 70. One-third of the patients were symptomatic, with amaurosis fugax in 12%, transient ischemic attack in 7%, and stroke in 16%. In total, 60 (15%) patients underwent shunting: 34 for a confirmed preoperative acute ischemic stroke, 22 for a stump pressure <30 mm Hg, and 4 for other indications. Overall 30-day death, ischemic ipsilateral stroke, myocardial infarction, and cranial nerve palsy rates were 0.5%, 0.8%, 1.8%, and 1.0%, respectively. No strokes occurred due to hypoperfusion, and all stroke symptoms resolved prior to discharge with a mean length of stay of 1.6 days.
conclusionsThis is one of the largest contemporary series of CEA using a 30 mm Hg threshold for selective shunting that demonstrated exceedingly low 30-day death and stroke events. Intraoperative carotid stump pressure measurements are a useful guide for selective shunting and reduction in perioperative stroke complications after CEA.
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