Research Article
Karotis Endarterektomi Operasyonu Sırasında Serebral Perfüzyonun Takibi ve Korunması: NIRS ve Kök Basıncı Rehberliğinde Seçici Şant Kullanımı
Abstract
Karotis arter cerrahisinde endarterektomi ve eversiyon metotları semptomatik veya asemptomatik hastalarda inme ve mortalite oranını azaltmaya yönelik uygulanan düşük riskli altın standart tedavi yöntemleridir. Serebral hipoperfuzyon ve iskeminin erken tespiti için yakın kızılötesi spektroskopi (NIRS) yöntemi ile rejyonel serebral oksijen saturasyonu (rSO2) ve karotis kök basıncı ölçümü yaygın kullanılan yöntemlerdir. Serebral hipoperfuzyonu engellemek ve serebral iskemi riskini azaltmak amaçlı en yaygın kullanılan yöntem intraoperatif şant kullanılmasıdır. Çalışmamızda karotis kök basıncı eşik değeri ≤40mmhg şant kullanımına karar verilen hastalarda, NIRS rSO2 değerindeki azalma, şant kullanımının peroperatif inme ve mortalite üzerine etkilerini araştırmayı amaçladık. 2018-2020 yılları arasında Kuzey Amerika semptomatik karotis endarterektomi çalışması (NASCET) kriterlerine göre %70-99 oranında darlık saptanan ve opere edilen 40 hasta retrospektif olarak değerlendirilmiştir. Şant kullanılan ve kullanılmayan grupta ipsilateral NIRS değerleri sırası ile ortalama klemp öncesi 70.33±8.40 ve 65.1±4.52, klemp konulduktan sonraki ilk dakikada 57.87±8.4 ve 62.01±4.6 saptandı (p<0.05). Çalışmamızda NIRS rSO2’deki ≥%15 düşme ile kök basıncı ≤40mmhg eşik değeri arasında iyi bir korelasyon olduğunu düşünmekteyiz. Bu değerler ile şant kullanım kararı verilen hastalarımızda peroperatif inme ve ölüm ile karşılaşılmamıştır. Ancak rSO2’deki düşmenin net bir sınır değerinin belirlenebilmesi için daha fazla prospektif ve çok merkezli çalışmalara ihtiyaç vardır.
Keywords
References
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Monitoring and Maintaining Cerebral Perfusion During Carotid Endarterectomy: Use of Selective Shunt Under NIRS and Root Pressure Guidance
Abstract
Endarterectomy and eversion methods in carotid artery surgery are low-risk gold standard treatment methods applied to reduce the rate of stroke and mortality in symptomatic or asymptomatic patients. Regional cerebral oxygen saturation (rSO2) by near infrared spectroscopy (NIRS) method and carotid root pressure measurement are commonly used methods for early detection of cerebral hypoperfusion and ischemia. The most commonly used method to prevent cerebral hypoperfusion and reduce the risk of cerebral ischemia is the use of intraoperative shunts. In our study, we aimed to investigate the effects of decrease in NIRS rSO2 value and the effects of shunt use on peroperative stroke/mortality in patients who were decided to use shunt with a carotid root pressure value of ≤40mmHg. Between 2018 and 2020, 40 patients with stenosis of 70-99% according to North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria and operated on were evaluated retrospectively. The mean ipsilateral NIRS values were 70.33±8.40 and 65.1±4.52 before clamping, 57.87±8.4 and 62.01±4.6 at the first minute after clamping in the shunt and non-shunt groups, respectively (p<0.05). In our study there is a good correlation between ≥15% reduction in NIRS rSO2 and ≤40mmHg root pressure threshold. Peroperative stroke and death were not encountered in our patients for whom the decision to use shunt was made with these values. However, we need larger prospective multicentre studies to identify the optimal cut-off value for the decrease in rSO2.
Keywords
References
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- 2. Liapis CD, Bell PR, Mikhailidis D, ve ark. ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg. 2009;37(4 Suppl):1-19.
- 3. Allen BT, Anderson CB, Rubin BG, ve ark. The influence of anesthetic technique on perioperative complications after carotid endarterectomy. J Vasc Surg. 1994;19(5):834-43.
- 4. Roger VL, Go AS, Lloyd-Jones DM, ve ark. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Circulation. 2011;123(4):e18-e209. 5. Bennett KM, Scarborough JE, Shortell CK. Predictors of 30-day postoperative stroke or death after carotid endarterectomy using the 2012 carotid endarterectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database. J Vasc Surg. 2015;61(1):103-11.
- 6. Goodney PP, Likosky DS, Cronenwett JL, Vascular Study Group of Northern New England. Factors associated with stroke or death after carotid endarterectomy in Northern New England. J Vasc Surg. 2008;48(5):1139-45.
- 7. Benington S, Pichel A. Anaesthesia for carotid endarterectomy. Current Anaesthesia & Critical Care 2008;19(3):138-49.
- 8. Rerkasem K, Rothwell PM. Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Cochrane Database Syst Rev. 2009;7(4):CD000190.
- 9. Woodworth GF, McGirt MJ, Than KD, ve ark. Selective versus routine intraoperative shunting during carotid endarterectomy: a multivariate outcome analysis. Neurosurgery. 2007;61(6):1170-7.
- 10. Aboyans V, Ricco JB, Bartelink MEL, ve ark. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018;39(9):763-816.
- 11. Erickson KM, Cole DJ. Review of developments in anesthesia for carotid endarterectomy. Curr Opin Anaesthesiol. 2005;18(5):466-70.
- 12. Gough MJ, Bodenham A, Horrocks M, ve ark. GALA: an international multicentre randomised trial comparing general anaesthesia versus local anaesthesia for carotid surgery. Trials. 2008;9:28.
- 13. Aburahma AF, Stone PA, Hass SM, ve ark. Prospective randomized trial of routine versus selective shunting in carotid endarterectomy based on stump pressure. J Vasc Surg. 2010;51(5):1133-8.
- 14. Kondov S, Beyersdorf F, Schöllhorn J, ve ark. Outcome of near-infrared spectroscopy-guided selective shunting during carotid endarterectomy in general anesthesia. Ann Vasc Surg. 2019;61:170-7. 15. Leopardi M, Musilli A, Piccolo E, ve ark. Multimodal neurophysiological monitoring reduces shunt incidence during carotid endarterectomy. Ann Vasc Surg. 2019;61:178-84.
- 16. Hudorovic N, Lovricevic I, Hajnic H, ve ark. Postoperative internal carotid artery restenosis after local anesthesia: presence of risk factors versus intraoperative shunt. Interact Cardiovasc Thorac Surg. 2010;11(2):182-4.
- 17. Wang Y, Li L, Wang T, ve ark. The Efficacy of near-infrared spectroscopy monitoring in carotid endarterectomy: A prospective, single-center, observational study. Cell Transplant. 2019;28(2):170-5.
- 18. Jonsson M, Lindström D, Wanhainen A, ve ark. Near infrared spectroscopy as a predictor for shunt requirement during carotid endarterectomy. Eur J Vasc Endovasc Surg. 2017;53(6):783-91.
- 19. Findlay JM, Kesarwani R, Jacka M, ve ark. Combined stump pressure and oximetry for shunt use during carotid endarterectomy. Can J Neurol Sci. 2017;44(6):692-6.
- 20. Pennekamp CW, Bots ML, Kappelle LJ, ve ark. The value of near-infrared spectroscopy measured cerebral oximetry during carotid endarterectomy in perioperative stroke prevention. A review. Eur J Vasc Endovasc Surg. 2009;38(5):539-45.
There are 18 citations in total.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Surgery |
| Journal Section | Original Article |
| Authors | |
| Publication Date | August 24, 2022 |
| Submission Date | December 25, 2021 |
| Published in Issue | Year 2022 Volume: 9 Issue: 2 |
