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Published on: May 9, 2013
[Shunting during carotid endarterectomy prevents postoperative cerebral hyperperfusion syndrome]
Leng Ni1, Chang-wei Liu, Bao Liu
1Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing 100730, China.
Insights
Using a shunt during carotid endarterectomy (CEA) significantly reduces the risk of cerebral hyperperfusion (CH) and cerebral hyperperfusion syndrome (CHS) post-surgery. This method effectively shortens intraoperative cerebral ischemia without increasing other complications.
Area of Science:
- Vascular Surgery
- Neurology
- Cerebrovascular Disease
Background:
- Carotid endarterectomy (CEA) is a procedure to remove plaque from carotid arteries.
- Cerebral hyperperfusion syndrome (CHS) is a potential complication after CEA.
- Intraoperative cerebral ischemia is a concern during CEA.
Purpose of the Study:
- To evaluate if shunting during CEA can decrease the incidence of postoperative cerebral hyperperfusion (CH) and CHS.
- To compare CH and CHS rates between patients who underwent CEA with and without shunting.
Main Methods:
- Prospective non-randomized controlled trial involving 180 patients undergoing CEA.
- Patients were divided into two groups: 81 with shunting and 99 without.
- Cerebral blood flow was monitored using Transcranial Doppler; CH and CHS rates were compared.
Main Results:
- The shunting group had significantly shorter clamping times (4 ± 4 min vs 26 ± 14 min).
- The incidence of CH was lower in the shunting group (7.4% vs 18.2%).
- The incidence of CHS was also lower in the shunting group (3.7% vs 12.1%).
Conclusions:
- Shunting during CEA effectively reduces the rates of CH and CHS.
- This is achieved by minimizing intraoperative cerebral ischemia duration.
- Shunting is a safe and potentially effective method for preventing CHS after CEA, particularly in high-risk patients.
Objective:
To assess if shunting during carotid endarterectomy (CEA) can lower the risk of postoperative cerebral hyperperfusion (CH) and cerebral hyperperfusion syndrome (CHS).
Methods:
This study was a prospective non-randomized controlled trial which approved by human rights committee of our hospital. From August 2009 to August 2012, 180 eligible patients with carotid arterial stenosis who had indication for CEA entered our study. 146 patients were males and 34 patients were females. Their age range was 38 - 83 years. Average age was (66 ± 9) years. Cerebral blood flow changes were monitored through Transcranial Doppler routinely. There were 81 cases with shunting and 99 without shunting. We compared the rate of CH, CHS and other complications between two groups.
Results:
No patient died or suffered hemorrhagic stroke. There were no significant difference in average operation time between two groups ((144 ± 25) min vs (139 ± 34) min, P > 0.05), but the clamping time of shunting group was significantly shorter than no shunting group ((4 ± 4) min vs (26 ± 14) min, P < 0.05). The rate of CH and CHS of shunting group is lower than no shunting group (7.4% vs 18.2%, P < 0.05; 3.7% vs 12.1%, P < 0.05). There were no differences in other complications between two groups.
Conclusion:
Shunting during CEA can lower the rate of CH and CHS by shortening the time of intraoperative cerebral ischemia, but didn't increase the rate of other complications. Using shunt may be an effective method of preventing CHS after CEA, especially for the high risk patients according to preoperative evaluation.
