Carotid endarterectomy without shunt

The role of cerebral metabolic protection

Miguel A. Melgar, Nitin Mariwalla, Hassan Madhusudan, Martin E Weinand

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: The optimal method to protect the brain from hemodynamic ischemia during carotid endarterectomy (CEA) remains controversial. This study reports our experience with induced arterial hypertension and selective etomidate cerebral protection in a cohort of patients who underwent CEA without shunting and continuous electroencephalography (EEG) monitoring. Methods: We reviewed retrospectively 102 consecutive CEAs performed in 102 patients with routine EEG monitoring and general anesthesia between March 1998 and October 2002. There were 65 (66%) symptomatic and 37 (34%) asymptomatic individuals. A protocol of induced arterial hypertension against EEG ischemic changes during carotid artery cross clamping was followed. Only patients with EEG changes refractory to induced hypertension went into etomidate-induced burst suppression. Results: EEG changes were classified as mild, moderate and severe. Twenty patients (19.6%) developed asymmetric EEG changes, of which the great majority were mild and moderate (75%, p<0.05). Seven patients with moderate (n=3) and severe (n=4) EEG changes needed etomidate cerebral protection. There were no mortalities and only one stroke (0.98%) is reported in the series. The morbidity rate was 6.8% and included transient cranial nerve palsies (n=5) and wound hematoma (n=1). Conclusions: Carotid endarterectomy can be safely performed with EEG monitoring and selective induced arterial hypertension and etomidate cerebral protection. Our results suggest that this method may be a good alternative for shunting and its inherent risks.

Original languageEnglish (US)
Pages (from-to)850-856
Number of pages7
JournalNeurological Research
Volume27
Issue number8
DOIs
StatePublished - Dec 2005

Fingerprint

Carotid Endarterectomy
Electroencephalography
Etomidate
Hypertension
Cranial Nerve Diseases
Brain Ischemia
Carotid Arteries
Constriction
Hematoma
General Anesthesia
Hemodynamics
Stroke
Morbidity
Mortality
Wounds and Injuries

Keywords

  • Carotid endarterectomy
  • Cerebral protection
  • Etomidate
  • Induced hypertension

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Carotid endarterectomy without shunt : The role of cerebral metabolic protection. / Melgar, Miguel A.; Mariwalla, Nitin; Madhusudan, Hassan; Weinand, Martin E.

In: Neurological Research, Vol. 27, No. 8, 12.2005, p. 850-856.

Research output: Contribution to journalArticle

Melgar, Miguel A. ; Mariwalla, Nitin ; Madhusudan, Hassan ; Weinand, Martin E. / Carotid endarterectomy without shunt : The role of cerebral metabolic protection. In: Neurological Research. 2005 ; Vol. 27, No. 8. pp. 850-856.
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