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Local haemodynamic changes during carotid endarterectomy--the influence on cerebral oxygenation
B Kragsterman1, H Pärsson, D Bergqvist
1Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Objectives:
To characterize carotid bifurcation haemodynamics and cerebral oxygenation during clamping and at reperfusion after carotid endarterectomy (CEA).
Materials And Methods:
Sixty-two patients with a symptomatic high-grade stenosis of the internal carotid artery (ICA), who underwent CEA under general anaesthesia, were studied prospectively. Measurements of stump-pressure, volume flow (transit time flowmetry) and changes in cerebral oxygenation (near-infrared spectroscopy (NIRS)) were performed. Selective shunting was based on stump pressure only.
Results:
Stump pressure correlated with both ICA flow before clamping (r=0.45; p=0.03) and changes in cerebral oxygenation (rSO2) during clamping (r=0.61; p=0.002), the latter was reversed by shunt placement. ICA flow before clamping also correlated with changes in rSO2 during clamping (r=0.41; p=0.01).
Conclusion:
Measurements with transit time flowmetry and cerebral oximetry are technically easy and help to determine the need for selective shunting during CEA. High ICA flow before clamping in combination with a low stump pressure usually indicates the need for a shunt. Volume flow measurements may also be useful in the quality assessment of the CEA.
