Stump pressure and transcranial Doppler for predicting shunting in carotid endarterectomy.
OBJECTIVE
to compare stump pressure (SP) and transcranial Doppler (TCD) with neurologic monitoring during carotid endarterectomy (CEA).


METHODS
one hundred and forty-seven CEAs performed under local anaesthesia.


METHODS
neurologic monitoring and SP were performed in all cases, while mean velocity of the middle cerebral artery (mvMCA) by TCD was done in 140/147 (95%) cases. Shunts were applied in all cases on the basis of neurologic monitoring. The following haemodynamic criteria have been compared to neurologic monitoring: (a) <25 mmHg SP; (b) <50 mmHg SP; (c) < or =10 cm/s mvMCA after carotid occlusion; (d) > or =70 decrease of mvMCA after carotid occlusion. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for each haemodynamic criterion.


RESULTS
shunt was used in 18/147 (12.2%) cases. With regards to <25 mmHg SP, < or =50 mmHg SP, < or =10 cm/s mvMCA after carotid occlusion, and > or =70 decrease of mvMCA after carotid occlusion, sensitivity resulted 33, 89, 80 and 80%, respectively. Specificity resulted 96, 82, 97 and 96%, respectively. Positive predictive value resulted 55, 41, 75 and 71%, respectively. Negative predictive value 91, 98, 98 and 98%, respectively. Accuracy resulted 88, 76, 89 and 94%, respectively.


CONCLUSIONS
none of the haemodynamic criteria by SP and TCD resulted absolutely reliable in predicting the need for carotid shunt.
Belardi
P
P
Vascular Surgery, Università degli Studi di Genova, Largo Rosanna Benzi 8, 16132 Genoa, Italy.
Lucertini
G
G
Ermirio
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002545:Brain Ischemia / Q000517:prevention & control; D017536:Carotid Artery, Common / Q000503:physiopathology* / Q000601:surgery; D016893:Carotid Stenosis / Q000503:physiopathology* / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D016343:Monitoring, Intraoperative / Q000379:methods*; D009460:Neurologic Examination; D018579:Patient Selection; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D017585:Ultrasonography, Doppler, Transcranial; D014656:Vascular Surgical Procedures / Q000379:methods