title: Brain Oxygen Supply Parameters in the Risk Assessment of Cerebral Complications During Carotid Endarterectomy.
abstract: OBJECTIVE
  To determine whether preoperative regional cerebral oxygen saturation (rSO2) and the decrease in rSO2during carotid clamping were predictive of the risk for neurologic complications in carotid endarterectomy and to determine the cutoff values of the studied parameters.
  
  
  METHODS
  Cohort, prospective, nonrandomized trial.
  
  
  METHODS
  Research Institute of Circulation Pathology, Novosibirsk, Russia.
  
  
  METHODS
  The study comprised 466 adults who underwent carotid endarterectomy since 2012.
  
  
  METHODS
  None.
  
  
  RESULTS
  Patient characteristics, postoperative complications, and brain oxygen supply during carotid endarterectomy were analyzed. The primary endpoints were the perioperative and early postoperative neurologic complications. Ischemic stroke was diagnosed in 1.5% of patients, and cognitive disorders were reported in 2.6% of patients. Preoperative rSO2of 50% was the cutoff value for the prediction of stroke outcome after carotid endarterectomy, with a sensitivity of 90.7% and specificity of 66.7%. A 20% decrease in rSO2during temporary carotid clamping was the cutoff value for the prediction of stroke, with a sensitivity of 86.0% and specificity of 57.1%, and for the prediction of cognitive disorders, with a sensitivity of 88.1% and specificity of 58.3%. Preoperative rSO2less than 50% and a decrease in rSO2of at least 20% during temporary carotid artery clamping caused a significant increase in the hospitalization period.
  
  
  CONCLUSIONS
  A 20% or more decrease in rSO2during temporary internal carotid artery clamping during carotid endarterectomy caused a 10-fold increased risk of ischemic stroke and an 8-fold increased risk of cognitive disorders, whereas preoperative rSO2less than 50% resulted in a 6-fold increased risk of ischemic stroke in the perioperative and early postoperative periods of carotid endarterectomy.
authors.affiliation: Clinical Physiology Group, Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors.forename: Oksana V
authors.initials: OV
authors.lastname: Kamenskaya
authors.affiliation: Clinical Physiology Group, Research Institute of Circulation Pathology, Novosibirsk, Russia. Electronic address: loginova_irina@ngs.ru.
authors.forename: Irina Yu
authors.initials: IY
authors.lastname: Loginova
authors.affiliation: Center of Anesthesiology and Critical Care Medicine, Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors.forename: Vladimir V
authors.initials: VV
authors.lastname: Lomivorotov
mesh_terms: D000368:Aged; D001921:Brain / Q000378:metabolism*; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism; D002560:Cerebrovascular Circulation / Q000502:physiology*; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism; D015331:Cohort Studies; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000639:trends*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods / Q000639:trends*; D008297:Male; D008875:Middle Aged; D010092:Oximetry / Q000379:methods / Q000639:trends; D010101:Oxygen Consumption / Q000502:physiology*; D011446:Prospective Studies; D018570:Risk Assessment; D019265:Spectroscopy, Near-Infrared / Q000379:methods
keywords: carotid endarterectomy; cerebral oxygen saturation; cognitive disorders; stroke