Correlation of cerebral oximetry with internal carotid artery stump pressures in carotid endarterectomy.
OBJECTIVE
This study compares internal carotid artery (ICA) mean stump pressures (SPs) with cerebral oximetry monitoring during carotid endarterectomy (CEA).


METHODS
A total of 104 consecutive patients undergoing CEA under general anesthesia (GA) during a 10-month period were prospectively evaluated. Baseline and postcarotid clamp regional cerebral oxygen saturation (rSO(2)) and mean ICA SPs were measured. Demographic, surgical, and medical variables were recorded for each case.


RESULTS
There were no postoperative strokes. Thirteen patients were excluded because of incomplete data. Of the 40 patients who had <10% drop in rSO(2), 6 had SP <40 mm Hg. Regional cerebral oxygen saturation with a 15% saturation drop threshold was 76.3% sensitive and 81.1% specific in detecting patients with SP <40 mm Hg. With a threshold of 20% drop, sensitivity and specificity were 57.9% and 86.8%, respectively.


CONCLUSIONS
Relative drop in rSO( 2) is neither sensitive nor specific in detecting patients with mean SP <40 mm Hg. These data do not support the use of cerebral oximetry as the sole monitoring modality during carotid endarterectomy under GA.
Manwaring
Mark L
ML
East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, Greenville, NC, USA.
Durham
Christopher A
CA
McNally
Michael M
MM
Agle
Steven C
SC
Parker
Frank M
FM
Stoner
Michael C
MC
D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D001794:Blood Pressure; D001795:Blood Pressure Determination; D002545:Brain Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000503:physiopathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010092:Oximetry; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity