Carotid artery stump pressure: its variability when measured serially.
At 189 operations in 174 patients, carotid artery stump pressure (CSP) was measured serially to determine variability during carotid endarterectomy with eucarbic general anesthesia. Overall, 34 of 174 (19.5%) had significant variation in CSP which would have affected selective use of a bypass shunt based on CSP criteria. In those with CSP initially below 50 torr, 26 of 76 (34%) rose above 50 torr even, though systemic pressure was constant or declined. Eight of 113 pts (7%) with initial CSP equal to or above 50 torr subsequent had CSP below 50 torr. CSP did not vary as a function of age, sex, intracranial disease judged by biplanar arteriography, or contralateral carotid stenosis but did vary with preoperative status. Asymptomatic patients had CSP above 50 torr in a high proportion of cases, 24 of 27 (89%) unlike those with TIA, 72 of 116 (62%) or prior stroke, 17 of 31 (54%) (P = 0.003). We conclude that carotid stump pressure is variable in many patients which may account for some of the conflicting observations on the need for shunts in carotid surgery.
Beebe
H G
HG
Section of Vascular Surgery, Virginia Mason Clinic, Seattle, Washington.
Starr
C
C
Slack
D
D
D001794:Blood Pressure; D001795:Blood Pressure Determination; D002340:Carotid Artery Diseases / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000502:physiology*; D004691:Endarterectomy; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000601:surgery*; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies