title: Cerebral oximetry and stump pressure as indicators for shunting during carotid endarterectomy: comparative evaluation.
abstract: The purpose of this work is to investigate the correlation between regional oxygen saturation (rSO(2)) changes and stump pressure (SP) during cross-clamping of the internal carotid artery in carotid endarterectomy (CEA) and verify the perspectives of rSO(2) to become a criterion for shunting. Sixty consecutive CEAs under general anesthesia were studied prospectively. Selective shunting was based on SP ≤40 mmHg exclusively. Regression analysis with high order terms and receiver operating characteristic analysis were performed to investigate the association between ΔrSO(2)(%) and SP and to determine an optimal ΔrSO(2)(%) threshold for shunt insertion. A quadratic association between ΔrSO(2)(%) and SP was documented regarding the baseline to one and five minutes after cross-clamping intervals. A cut-off of 21 and 10.1% reduction from the baseline recording was identified as optimal for the distinction between patients needed or not a shunt regarding the first and fifth minute after cross-clamping, respectively. In conclusion, cerebral oximety reflects sufficiently cerebral oxygenation during CEA compared with SP, providing a useful mean for cerebral monitoring.
authors.affiliation: Department of Surgery, University of Ioannina, Ioannina, Greece.
authors.forename: Charalambos L
authors.initials: CL
authors.lastname: Tambakis
authors.forename: George
authors.initials: G
authors.lastname: Papadopoulos
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Sergentanis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Lagos
authors.forename: Eleni
authors.initials: E
authors.lastname: Arnaoutoglou
authors.forename: Nicos
authors.initials: N
authors.lastname: Labropoulos
authors.forename: Miltiadis I
authors.initials: MI
authors.lastname: Matsagkas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D001795:Blood Pressure Determination; D002340:Carotid Artery Diseases / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D003250:Constriction; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006115:Greece; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012044:Regression Analysis; D019265:Spectroscopy, Near-Infrared; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010100:Oxygen