European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery · 2001
External carotid artery shunting during carotid endarterectomy: an alternative for cerebral protection?
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Belardi P, Finocchi C, Lucertini G, Viacava A, Simoni G
Аннотация
OBJECTIVES: to assess the application of external carotid artery (ECA) shunting in cerebral protection during carotid endarterectomy (CEA).
DESIGN: prospective study.
MATERIALS AND METHODS: the study comprised 137 consecutive patients who underwent CEA under locoregional anaesthesia. Transcranial Doppler was used to monitor the mean velocity of the middle cerebral artery (mv-MCA): (1) before carotid clamping; (2) after clamping both the common and external carotid arteries; (3) after clamping the internal carotid artery alone ("ECA test"). The decision to shunt was based on the occurrence of neurological deficit during carotid clamping. If the ECA test revealed mv-MCA approaching the pre-clamping values ECA shunting was used, whereas the remaining patients in need of a shunt had a standard internal carotid artery (ICA) shunt.
RESULTS: shunting was necessary in 12/137 cases (9%). The ECA test indicated that in four cases - 3% of the whole series or 33% of the shunted cases. In these four patients ECA shunting reversed the neurological deficit, and CEA was successfully performed without any complications.
CONCLUSIONS: ECA shunting could be considered as an alternative to standard ICA shunting. Suitable cases can be identified on the basis of the ECA test.
DESIGN: prospective study.
MATERIALS AND METHODS: the study comprised 137 consecutive patients who underwent CEA under locoregional anaesthesia. Transcranial Doppler was used to monitor the mean velocity of the middle cerebral artery (mv-MCA): (1) before carotid clamping; (2) after clamping both the common and external carotid arteries; (3) after clamping the internal carotid artery alone ("ECA test"). The decision to shunt was based on the occurrence of neurological deficit during carotid clamping. If the ECA test revealed mv-MCA approaching the pre-clamping values ECA shunting was used, whereas the remaining patients in need of a shunt had a standard internal carotid artery (ICA) shunt.
RESULTS: shunting was necessary in 12/137 cases (9%). The ECA test indicated that in four cases - 3% of the whole series or 33% of the shunted cases. In these four patients ECA shunting reversed the neurological deficit, and CEA was successfully performed without any complications.
CONCLUSIONS: ECA shunting could be considered as an alternative to standard ICA shunting. Suitable cases can be identified on the basis of the ECA test.