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Stump pressure, the contralateral carotid artery, and electroencephalographic changes
K J Cherry1, C F Roland, J W Hallett
1Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905.
American Journal of Surgery
|August 11, 1991
Summary
Electroencephalographic (EEG) monitoring and stump pressure help assess cerebral ischemia risk during carotid endarterectomy. Stump pressure under 50 mm Hg effectively identifies patients with EEG changes, indicating potential issues.
Area of Science:
- Neurology
- Vascular Surgery
- Cerebrovascular Medicine
Background:
- Cerebral ischemia risk during carotid endarterectomy is primarily assessed using electroencephalographic (EEG) monitoring and stump pressure.
- The influence of the contralateral carotid artery's status on shunt necessity and cerebral ischemia risk is recognized but not fully understood.
- The interplay between EEG monitoring, stump pressure, and contralateral carotid artery status requires further delineation.
Purpose of the Study:
- To retrospectively analyze the relationship between EEG monitoring, stump pressure, and contralateral carotid artery status in patients undergoing carotid endarterectomy.
- To determine the predictive value of stump pressure and contralateral carotid artery status for identifying cerebral ischemia risk.
Main Methods:
- Retrospective review of 124 carotid endarterectomies in 113 patients.
- Assessment of three key variables: EEG monitoring, stump pressure, and contralateral carotid artery status (occluded, stenotic, or nonstenotic).
- Statistical analysis to correlate these variables with the incidence of EEG changes.
Main Results:
- Higher incidence of EEG changes observed with contralateral carotid artery occlusion (48%) compared to stenosis (18%) or nonstenotic arteries (21%).
- Significant correlation between lower stump pressure and increased EEG changes: 73% incidence with <25 mm Hg, 32% with 25-50 mm Hg, and 2% with >50 mm Hg.
- Stump pressure ≤50 mm Hg demonstrated high sensitivity (97%) in identifying patients with EEG changes, particularly when combined with contralateral occlusion.
Conclusions:
- While stump pressure and contralateral artery status do not perfectly predict EEG changes in all cases, they provide valuable risk stratification.
- Low stump pressure (<50 mm Hg) is a sensitive indicator for potential cerebral ischemia during carotid endarterectomy.
- Combined assessment of stump pressure and contralateral carotid artery status can aid in managing patients undergoing carotid endarterectomy.