[Thoughts about brain protection in carotid surgery].
Brain protective measures and monitoring devices in carotid surgery tend towards absolute prevention of strokes without totally achieving this objective. When a post-operative stroke occurs, the question is: is it a brain protection failure, a technical fault or an ill-advised indication? However, apart from massive stroke, other significant disorders may occur especially affecting higher functions. We studied a series of 126 patients with a mean age of 68.4 years who underwent 140 carotid repairs. The average clamping time was 21.8 min. Brain protection always consisted of: general anesthesia and heparinization, hyperoxygenation, light hypercapnia without shunting or monitoring. Two deaths and one hemiplegia (2.1%) were due to an incorrect indication or technical error. Three resolving neurological events were related to clamping intolerance (2.1%). What appears to be responsible, in case of stroke, is not so much clamping but technical errors. We also observed disturbances of higher functions in 25 patients (17.8%). A study using psychometric tests performed preoperatively and at a convenient time from the operation is proposed in order to demonstrate carotid clamping effects on higher functions.
Moreau
P
P
Centre Médical du Trencavel, Béziers.
Bonnaure
E
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods*; D016893:Carotid Stenosis / Q000601:surgery*; D002539:Cerebral Arterial Diseases / Q000517:prevention & control*; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006429:Hemiplegia / Q000209:etiology; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011183:Postoperative Complications
D006493:Heparin
Réflexions à propos de la protection cérébrale dans la chirurgie carotidienne.