Stroke prevention during carotid surgery in high risk patients (value of transcranial Doppler and local anesthesia).
In a series of 114 cases, carotid surgery was performed under local anesthesia by cervical block in order to assess cerebral status. Preoperative transcranial Doppler was used to select high risk patients for shunting. Intraoperatively brain function was checked by carotid arterial blood pressure monitoring and transcranial Doppler. No stroke occurred during the procedure. Postoperatively two deaths (1.8%) occurred, one due to intracerebral hemorrhage and one to a late myocardial infarct. The predictive value of both transcranial Doppler and stump pressure monitoring for shunting was 97% respectively. In combination, the two methods provided 100% protection. During the same period, 1406 patients underwent carotid surgery under general anesthesia. Carotid surgery stroke can be prevented either by using transcranial Doppler together with carotid stump pressure monitoring when the procedure is performed under general anesthesia or by operating under local anesthesia.
Bergeron
P
P
Fondation Hôpital Saint-Joseph, Marseille, France.
Benichou
H
H
Rudondy
P
P
Jausseran
J M
JM
Ferdani
M
M
Courbier
R
R
D000368:Aged; D000772:Anesthesia, Local; D001340:Autonomic Nerve Block; D001795:Blood Pressure Determination; D016893:Carotid Stenosis / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000517:prevention & control*; D002572:Cervical Plexus; D004453:Echoencephalography; D016894:Endarterectomy, Carotid / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D016343:Monitoring, Intraoperative / Q000379:methods; D011237:Predictive Value of Tests; D012307:Risk Factors