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Cerebral ischemia during carotid endarterectomy - analyses of markers for inflammation and haemostasis
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
Manuscript (Other academic)
URN: urn:nbn:se:uu:diva-94427OAI: oai:DiVA.org:uu-94427DiVA: diva2:168267
Available from: 2006-05-03 Created: 2006-05-03 Last updated: 2010-01-13Bibliographically approved
In thesis
1. Carotid Artery Stenosis: Surgical Aspects
Open this publication in new window or tab >>Carotid Artery Stenosis: Surgical Aspects
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Randomised controlled trials (RCT) have demonstrated a net benefit of carotid endarterectomy (CEA) in stroke prevention for patients with severe carotid artery stenosis as compared to best medical treatment. Results in routine clinical practice must not be inferior to those in the RCTs. The carotid arteries are clamped during CEA which may impair the cerebral perfusion.

The aim of this thesis was to assess population-based outcomes from CEA, investigate risk factors for perioperative complications/late mortality and to evaluate effects of carotid clamping during CEA. In the Swedish vascular registry 6182 CEAs were registered during 1994-2003. Data on all CEAs were retrieved, analysed and validated. In the validation process no death or disabling stroke was unreported. The perioperative stroke or death rate was 4.3% for those with symptomatic and 2.1% for asymptomatic stenosis (the latter decreasing over time). Risk factors for perioperative complications were age, indication, diabetes, cardiac disease and contralateral occlusion. Median survival time was 10.8 years for the symptomatic and 10.2 years for the asymptomatic group.

Tolerance to carotid clamping during CEA under general anaesthesia was evaluated in 62 patients measuring cerebral oximetry, transit time volume flowmetry and stump pressure. High internal carotid artery flow before clamping and low stump pressure was associated with decreased oxygenation after clamping suggesting shunt indication.

In 18 patients undergoing CEA, jugular bulb blood samples demonstrated significantly altered levels of marker for inflammatory activation (IL-6) and fibrinolytic activity (D-dimer and PAI-1) during carotid clamping as compared to radial artery levels. This indicates a cerebral ischaemia due to clamping although clinically well tolerated.

In conclusion, the perioperative outcome after CEA in Sweden compared well with the RCTs results. Tolerance to carotid clamping may be evaluated by combining stump pressure and volume flow measurements. Although clinically tolerated clamping may induce a cerebral ischaemic response.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2006. 68 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 151
Surgery, carotid endarterectomy, carotid artery stenosis, carotid clamping, cerebral ischaemia, Kirurgi
urn:nbn:se:uu:diva-6834 (URN)91-554-6564-1 (ISBN)
Public defence
2006-05-24, Auditorium Minus, Museum Gustavianum, 13:30
Available from: 2006-05-03 Created: 2006-05-03Bibliographically approved

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