title: Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: Observational case series.
abstract: BACKGROUND
  Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another.
  
  
  METHODS
  A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS). The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery) in any single institution will be small and hence there is a lack of large randomized studies.
  
  
  RESULTS
  This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8). In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends) was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO 2 , etc.,) were taken.
  
  
  CONCLUSIONS
  The study shows good clinical outcome with the use of NIRS. This is our "work in progress," and we aim to conduct a larger study.
authors.forename: Dincer
authors.initials: D
authors.lastname: Aktuerk
authors.affiliation: Department of Cardiothoracic Surgery, Cardiothoracic Unit, Heart and Lung Centre, Wolverhampton, WV10 0QP, United Kingdom.
authors.forename: Pankaj Kumar
authors.initials: PK
authors.lastname: Mishra
authors.forename: Heyman
authors.initials: H
authors.lastname: Luckraz
authors.forename: Andrew
authors.initials: A
authors.lastname: Garnham
authors.forename: Fayaz Mohammed
authors.initials: FM
authors.lastname: Khazi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001923:Brain Chemistry; D002245:Carbon Dioxide / Q000378:metabolism; D006348:Cardiac Surgical Procedures / Q000379:methods*; D016893:Carotid Stenosis / Q000378:metabolism*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010100:Oxygen / Q000032:analysis*; D010101:Oxygen Consumption; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared; D020521:Stroke / Q000517:prevention & control
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen