Routine versus selective near-infrared spectroscopy-guided shunting during carotid eversion endarterectomy

Area of Science:

• Neurosurgery
• Vascular Surgery
• Anesthesiology
• Medical Technology

Background:

• Carotid endarterectomy (CEA) is a surgical procedure to remove plaque from the carotid artery.
• Shunting is used during CEA to maintain cerebral blood flow, but the optimal strategy is debated.
• Near-infrared spectroscopy (NIRS) monitors regional cerebral oxygen saturation, potentially guiding shunting decisions.

Purpose of the Study:

• To compare the outcomes of routine shunting versus NIRS-guided selective shunting in patients undergoing CEA.
• To evaluate the impact of shunting strategy on perioperative stroke and in-hospital mortality.

Main Methods:

• Retrospective analysis of patients undergoing CEA of the internal carotid artery (ICA) between January 2011 and January 2019.
• Patients were divided into routine-shunting and NIRS-guided selective-shunting groups.
• One-to-one propensity score matching was used to compare outcomes, with perioperative stroke and in-hospital mortality as primary endpoints.

Main Results:

• NIRS-guided selective shunting was used in 66.0% of patients, while routine shunting was used in 34.0%.
• The perioperative stroke rate was significantly lower in the NIRS-guided selective-shunting group (1.1%) compared to the routine-shunting group (4.0%).
• Routine shunting and advanced age were identified as risk factors for perioperative stroke.

Conclusions:

• NIRS-guided selective shunting is associated with a lower incidence of perioperative stroke during CEA under general anesthesia.
• This finding suggests that NIRS monitoring can optimize shunting strategies, potentially improving patient safety during CEA.