[Current aspects of cerebral protection in carotid surgery: update].
The goal of cerebral protection in carotid surgery is to reduce postoperative central neurological complications and thus reduce morbidity-mortality of carotid endarterectomy. With improving understanding of the mechanism leading to neurological complications, means of achieving cerebral protection have been developed. Preoperative evaluation of the ischemic risk is based on the neurological examination and on computed tomography and magnetic resonance imaging findings. The possibilities of arterial supply during carotid cross-clamping can be recognized with the help of arteriography, transcranial Doppler or angio-MRI. Selective or systematic use of an intraluminal shunt and preoperative heparin therapy are the main methods used for cerebral protection. The risk of early postoperative stroke can also be reduced by careful preoperative anatomic control to detect any technical failure. Discussion on the usefulness of monitoring cerebral function during the procedure is closely related to the experience of the surgical team. The only method currently accepted by all surgeons is the use of stents during carotid angioplasty to achieve cerebral protection.
Jausseran
J M
JM
Service de Chirurgie Vasculaire, Hôpital Saint-Joseph, 26, bd de Louvain, 13008 Marseille.
Valerio
N
N
Houel
F
F
Ferdani
M
M
Rudondy
P
P
Albrand
J J
JJ
Spinetti
F
F
D000768:Anesthesia, General; D000772:Anesthesia, Local; D000800:Angioplasty, Balloon / Q000009:adverse effects; D000925:Anticoagulants / Q000627:therapeutic use; D001794:Blood Pressure; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D016893:Carotid Stenosis / Q000601:surgery*; D004569:Electroencephalography; D004691:Endarterectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005073:Evoked Potentials, Somatosensory; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D018810:Magnetic Resonance Angiography; D016343:Monitoring, Intraoperative; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D011292:Premedication; D015607:Stents; D017585:Ultrasonography, Doppler, Transcranial
D000925:Anticoagulants; D006493:Heparin; D010100:Oxygen
Aspects actuels de la protection cérébrale en chirurgie carotidienne: mise au point.