[Predictors of cerebral complications during carotid endarterectomy]
O V Kamenskaya1, I Yu Loginova1, V V Lomivorotov1
1Research Institute of Circulation Pathology, Novosibirsk, Russia.
Insights
Cerebral oxygenation monitoring during carotid endarterectomy can predict stroke risk. A drop in regional cerebral oxygenation (rSO2) by ≥20% or levels <50% significantly increase the risk of ischemic stroke (IS) post-surgery.
Area of Science:
- Neurology
- Vascular Surgery
- Critical Care Medicine
Background:
- Carotid endarterectomy (CEE) is a procedure to prevent ischemic stroke (IS).
- Predicting perioperative IS risk is crucial for patient management.
- Cerebral oxygenation monitoring offers potential insights into intraoperative risks.
Purpose of the Study:
- To assess the prognostic value of cerebral oxygenation parameters.
- To estimate the risk of IS in the perioperative and early postoperative phases of CEE.
- To identify key indicators of IS risk during CEE.
Main Methods:
- Study included 466 patients undergoing CEE with bilateral cerebral oxygenation monitoring (rSO2).
- The primary endpoint was the occurrence of cerebral complications.
- Analysis focused on perioperative rSO2 levels and changes during carotid artery occlusion.
Main Results:
- Perioperative rSO2 <50% was a strong predictor of IS (AUC 0.85).
- A reduction in rSO2 by ≥20% during carotid occlusion also predicted IS (AUC 0.74).
- High-risk patients had collateral stenosis, internal carotid artery (ICA) occlusion, or a history of myocardial infarction.
Conclusions:
- A ≥20% reduction in rSO2 during ICA occlusion increased IS risk over 10-fold.
- Perioperative rSO2 <50% increased IS risk by 6-fold.
- Cerebral oxygenation monitoring is valuable for predicting IS risk after CEE.
Aim:
To evaluate the prognostic value of parameters of cerebral oxygenation in estimation of the risk of ischemic stroke (IS) in perioperative and early postoperative phase of carotid endarterectomy (CEE).
Material And Methods:
Four hundred and sixty-six patients with hemodynamically significant atherosclerotic lesion of arteries of the brachiocephalic system, who underwent CEE with bilateral monitoring of cerebral oxygenation (rSO2), were enrolled. The end-point of the study was cerebral complications in perioperative and early postoperative phase.
Results:
The perioperative level of rSO2 <50% (AUC 0.85 (0.73-0.96), p<0.05) and the reduction in rSO2 in the operated side during the temporary occlusion of the inner carotid artery (ICA) by ≥20% (AUC 0.74 (0.51-0.97) p<0.05) were the best predictors of the risk of IS. The risk group with the reduction in rSO2 by ≥20% at the main stage of CEE included patients with collateral stenosis and ICA occlusion, occlusion of the circle of Willis and the history of myocardial infarction.
Conclusion:
The reduction in rSO2 in the stage of ICA occlusion by ≥20% increased the risk of IS by >10 times, the perioperative level of rSO2 <50% increased the risk of IS in perioperative and early postoperative phase of CEE by 6 times.
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