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Near Infrared Spectroscopy as a Predictor for Shunt Requirement During Carotid Endarterectomy
Karolinska Inst, Sodersjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden.;Soder Sjukhuset, Sect Vasc Surg, Dept Surg, S-11883 Stockholm, Sweden..
Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Gävle Hospital, Sweden..
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2017 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 53, no 6, 783-791 p.Article in journal (Refereed) Published
Abstract [en]

Objective/Background: Near infrared speCtroscopy (NIRS) continuously monitors regional cerebral oxygenation (rSO2) in the frontal lobes. This method may be used in patients during carotid endarterectomy to indicate the need for shunting. The aim of the study was to evaluate the value of NIRS in determining the need for selective shunting during CEA. A secondary aim was to compare NIRS with stump pressure.

Methods: Between January 2013 and October 2016, 185 patients from two vascular units, undergoing CEA under local anaesthesia were prospectively included. All patients gave informed consent to participate; there were no exclusion criteria. A Foresight® oximeter was used for rSO2 measurement, which was compared with stump pressure. Receiver operating characteristic curve analysis was used to identify optimal cutoff points, and sensitivity, specificity, and positive and negative predictive values were calculated.

Results: Twenty patients (10.8%) developed neurological symptoms during clamping. Mean stump pressure was lower in the group that developed neurological symptoms than in the group who did not (34 +/- 19 mmHg vs. 55 +/- 17 mmHg [p < . 01]). Corresponding NIRS results for the decrease in rSO2 on the ipsilateral side was 15 +/- 7% versus 4 +/- 6% (p < .01). Using stump pressure <= 50 mmHg as cutoff value for predicting symptoms, the sensitivity was 85% (95% confidence interval [CI] 64-95) and specificity 54% (95% CI 46-61). With a relative decrease in NIRS saturation (triangle rSO2) of 9%, sensitivity was 95% (95% CI 76-99), and specificity 81% (95% CI 74-86) to predict ischaemic symptoms during carotid clamping. Neurological deterioration during carotid clamping was detected in one patient with a relative decrease in rSO2 of <9% compared with three patients with a stump pressure >50 mmHg.

Conclusion: NIRS allows continuous non-invasive monitoring of cerebral oxygenation during CEA, with high sensitivity and acceptable specificity in predicting cerebral ischaemia and the need for shupting, which makes it an attractive alternative to stump pressure.

Place, publisher, year, edition, pages
2017. Vol. 53, no 6, 783-791 p.
Keyword [en]
Carotid endarterectomy, Cerebral oximetry, Local anesthesia, Near-infrared spectroscopy, Selective shunting, Stump pressure
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-329710DOI: 10.1016/j.ejvs.2017.02.033ISI: 000403518800005PubMedID: 28431821OAI: oai:DiVA.org:uu-329710DiVA: diva2:1147328
Available from: 2017-10-05 Created: 2017-10-05 Last updated: 2017-10-05Bibliographically approved

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Wanhainen, AndersDjavani Gidlund, Khatereh

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