title: Surgical dissection of the internal carotid artery under flow control by proximal vessel clamping reduces embolic infarcts during carotid endarterectomy.
abstract: OBJECTIVE
  To evaluate the efficacy of flow control of the internal carotid artery (ICA) by the clamping of the common carotid artery, external carotid artery, and superior thyroid artery during surgical ICA dissection to reduce ischemic complications after carotid endarterectomy (CEA).
  
  
  METHODS
  Sixty-seven patients (59 men; age, 70.5 ± 6.2 years) who underwent CEA by the same surgeon were retrospectively studied. Both conventional CEA (n = 29) and flow-control CEA (n = 38) were performed with the patient under general anesthesia and with the use of somatosensory-evoked potential and near-infrared spectroscopy monitoring as a guide for selective shunting. The number of new postoperative infarcts was assessed with preoperative and postoperative diffusion-weighted images (DWIs) obtained within 3 days of surgery. In addition to surgical technique, the effects of the following factors on new infarcts also were examined: age, side of ICA stenosis, high-grade stenosis, symptoms, and application of shunting.
  
  
  RESULTS
  New postoperative DWI lesions were observed in 7 of 67 patients (10.4%), and none of them was symptomatic. With respect to operative technique, the incidence rate of DWI spots was significantly lower in the flow-control group (2.6%) than in the conventional group (20.7%), odds ratio: 0.069; 95% confidence interval: 0.006-0.779; P = 0.031). On multiple logistic regression analysis, age, side of ICA stenosis, high-grade stenosis, symptoms, and the use of internal shunting did not have significant effects on new postoperative DWI lesions, whereas technique did have an effect.
  
  
  CONCLUSIONS
  The proximal flow-control technique for CEA helps avoid embolic complications during surgical ICA dissection.
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: kazuy@kuhp.kyoto-u.ac.jp.
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kurosaki
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Funaki
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kikuchi
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Ishii
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Jun C
authors.initials: JC
authors.lastname: Takahashi
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takagi
authors.affiliation: Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Sen
authors.initials: S
authors.lastname: Yamagata
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyamoto
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery; D002544:Cerebral Infarction / Q000209:etiology / Q000517:prevention & control*; D016001:Confidence Intervals; D003250:Constriction; D038524:Diffusion Magnetic Resonance Imaging; D016894:Endarterectomy, Carotid / Q000379:methods*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D019635:Neurosurgical Procedures / Q000379:methods*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D019265:Spectroscopy, Near-Infrared; D016896:Treatment Outcome
keywords: Carotid endarterectomy; Diffusion-weighted imaging; Embolization; Surgical technique