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Revista chilena de cirugía

On-line version ISSN 0718-4026

Abstract

BOMBIN, Juan et al. Carotid Endarterectomy with routine carotid stump pressure measurement, intraoperative hemodynamic management and selective use of shunt. Rev Chil Cir [online]. 2018, vol.70, n.1, pp.35-39. ISSN 0718-4026.  http://dx.doi.org/10.4067/S0718-40262018000100035.

Introduction

During carotid endarterectomy (CEA) clamping cerebral perfusion is maintained by contralateral circulation through the Circle of Willis and it is correlated to the stump pressure (SP). If it is below 50 mmHg there is risk of stroke due to hypoperfusion and a shunt must be used, but systemic blood pressure can be temporarily elevated making the use of shunt unnecessary.

Aim

Results of CEA with SP measurement to evaluate cerebral perfusion in cross-clamped hemisphere and hemodynamic intraoperative management reducing the use of shunt.

Material and Methods

Retrospective study of CEAs performed in 73 patients under general anaesthesia with SP measurement, hemodynamic management and selective use of shunt. Demographics, clinical and perioperative morbimortality variables were analized.

Results

73 patients, average age 71.1 years, 69.9% symptomatic. In 54 patients SP was above 50 mmHg and shunt was not used, in 19 SP was below 50 mmHg, it was elevated through intraoperative hemodynamic management and shunt was not needed. In only 3 cases SP did not reach 50 mmHg and a Pruitt-Inahara shunt was used. Two patients presented postoperative transient central neurological deficit and 2 died due to myocardial infarction.

Conclusion

CEA with SP measurement and hemodynamic management reduced the use of carotid shunting and it was a safe procedure to treat patients with severe carotid stenosis who need surgical intervention.

Keywords : Carotid endarterectomy; Stump pressure; Selective use of carotid shunt.

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