[Hemodynamic reserve in carotid surgery and the use of "superselective" shunt].
The aim of this study is to establish whether a preoperative evaluation of the Cerebral Hemodynamic Reserve, carried out by means of transcranial Doppler and SPECT with provocative test (acetazolamide) can single out those patients who, because they are supplied with a poor cerebral reserve, are truly in need of intraoperative shunting after carotid clamping. All patients were intraoperatively monitored by means of Somato Sensitive Evoked Potentials (SSEPs). Those patients who were shunted due to abnormalities in SSEPs were also those who showed a perfusion and velocity increase below 15%, and therefore supplied, in our opinion, with a scanty cerebral reserve. No, but one, neurological deficit appeared on awakening in patients who were not shunted.
Palombo
D
D
Unità di Chirurgia Vascolare ed Angiologia, Ospedale Regionale della Valle d'Aosta, Aosta.
Porta
C
C
Peinetti
F
F
Brustia
P
P
Udini
M
M
Antico
A
A
Carmonini
A
A
Cantalupi
D
D
Varetto
T
T
D000086:Acetazolamide; D000368:Aged; D002339:Carotid Arteries / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D000086:Acetazolamide
Riserva emodinamica in chirurgia carotidea ed uso "superselettivo" dello shunt.