Diana Bilskienė, Dalia Urbanaitė, Alina Vilkė, Gediminas Banevičius, Andrius Macas
Carotid endarterectomy remains the „gold standard of treatment“ for patients with high-grade atherosclerotic carotid stenosis. The aim of this procedure is to relieve neurological symptoms, to re-establish blood flow and to prevent complications, such as cerebral ischemia, intracerebral hematoma, myocardial infarction or death. However, the procedure bears it‘s own risks. At the moment of carotid artery cross-clamping, cerebral hypoperfusion may occur followed by cerebral oxygen supply decrease. Such alteration may additionally be influenced by insufficient collateral cerebral blood flow. In these situations a temporary shunt may be inserted to maintain adequate cerebral perfusion and oxygenation in order to achieve a good neurological outcome. Even though the shunting procedure can restore cerebral perfusion, it also may cause embolisation and endothelial damage which may lead to an intraoperative stroke. In order to reduce the rates of these complications, intensive neuromonitoring becomes a must. However, there are still no consensus which neuromonitoring method should be used and when the shunt should be placed. It depends on anaesthesiologists who use different techniques to determine reliable changes of cerebral perfusion and oxygenation. Therefore, this article review the current use of neuromonitoring techniques such as electroencephalography, transcranial doppler ultrasonography, cerebral oximetry, continuous clinical assessment in the awake patient during carotid endarterectomies.
Keyword(s): internal carotid artery, endarterectomy, stroke, hypoperfusion, cerebral hyperperfusion syndrome, cerebral oximetry, transcranial doppler ultrasonography, monitoring.
Full Text: PDF