Cor Vasa 2019, 61(4):e420-e425 | DOI: 10.33678/cor.2019.055

Impact of contralateral carotid stenosis on brain tissue oxygenation during carotid endarterectomy

Marek Lukeš^a,b, Martin Helán^a,b,c, Vladimír Šrámek^a,b, Jana Pavlíková^a, Robert Staffa^b,d, Pavel Suk^a,b,c

^a Department of Anesthesiology and Intensive Care, St. Anne's University Hospital, Brno

^b Faculty of Medicine, Masaryk University, Brno

^c International Clinical Research Center (ICRC), St. Anne's University Hospital, Brno

^d 2^nd Department of Surgery, Center for Vascular Diseases, St. Anne's University Hospital, Brno

Background: Cerebral oximetry (rSO₂) seems to be a promising technique for assessment the adequacy of cerebral oxygen delivery during carotid endarterectomy (CEA). The purpose of this study was to evaluate the association of the severity of contralateral (non-operated) carotid artery stenosis and the magnitude of rSO₂ changes during CEA.

Methods: rSO₂ was monitored in 38 patients undergoing CEA under regional anesthesia. Patients were retrospectively assigned to one of two groups: with (Gdef) or without (Gnodef) change in neurological status. Baseline rSO₂ values (rSO₂base), average (rSO₂avg) and minimal (rSO₂min) values during 3 minutes after clamping, and rSO₂ change after clamping (∆rSO₂avg and ∆rSO₂min) were compared between both groups. The influence of contralateral carotid artery stenosis on rSO₂ was assessed by correlation. Data are presented as median (IQR).

Results: Neurologic deterioration has developed in 4 patients. We did not find any statistical difference in rSO₂ values between Gdef a Gnodef on operated side - rSO₂base was 79 (75-87) in Gnodef and 79 (64-90) in Gdef (p = 0.84), rSO₂min 74 (65-81) in Gnodef and 75 (59-90) in Gdef (p = 0.70), and ∆rSO₂min 6 (2-13) in Gnodef and 2 (0-6) in Gdef (p = 0.15). Similarly, there was not any difference between groups if rSO₂ was measured on contralateral side. We showed that non-operated ACI stenosis was a risk factor for developing of perioperative neurological deficit, but we did not demonstrate any influence of non-operated ACI stenosis severity on rSO₂ values.

Conclusion: We did not prove any association between the severity of contralateral carotid artery stenosis and the magnitude of rSO₂ changes during CEA. Cerebral oximetry was not able to predict the development of neurologic deficit during CEA.

Keywords: Carotid endarterectomy, Cerebral ischemia, Cerebral oximetry, Cerebrovascular monitoring, Near-infrared spectroscopy

Received: January 9, 2019; Accepted: June 25, 2019; Published: August 11, 2019  Show citation