[Carotid endarterectomy under regional anesthesia: intraoperative criteria for placing a temporary intraluminal shunt (meta-analysis)].

OBJECTIVE

Conducting a meta-analysis to assess consistency between the indices of cerebral oxygenation (near infrared spectrometry, NIRS), clinical data, pressure in the stump, findings of transcranial Doppler ultrasonography, and neurosensory status of patients, as well as to determine optimal comprehensive criteria for making a decision on a temporary intravascular shunt during carotid endarterectomy under regional anesthesia.

MATERIAL AND

METHODS

A systematic search was carried out in databases PubMed, Medline and Cochrane Library over the period from January 2015 to October 2025.

INCLUSION CRITERIA: prospective observational studies or randomized controlled studies with participation of patients subjected to carotid endarterectomy under regional anesthesia, assessing consistency of instrumental methods of monitoring and clinical picture. The statistical analysis was performed in the R program (version 4.2.1).

RESULTS

The final analysis included 13 studies (1894 patients). The overall frequency of selective shunting amounted to 11.51% (95% confidence interval 10.11-13.03%). An optimal criterion for placement of a temporary shunt was a decrease of δrSO2 ≥9-10% in combination with the appearance of neurological deficit (sensitivity 90-100% and specificity 70-83%). Multimodal methods of monitoring demonstrated the average AUC 0.90 vs 0.87 for double combinations. The perioperative stroke rate amounted to 1.48% (95% confidence interval 1.11-2.25%), thus corresponding to the modern international quality standards.

CONCLUSION

A combined approach with the use of NIRS-monitoring (threshold of δrSO2 ≥9-10%) jointly with clinical assessment of the neurological status is an optimal criterion for selective shunting in carotid endarterectomy under regional anesthesia. Multimodality monitoring increases the diagnostic accuracy, making it possible to minimize the risk of ischemic complications.