gms | German Medical Science

71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Non-invasive autoregulation monitoring in awake patients duringcarotid endarterectomy in relation to neurological status

Nicht-invasives Autoregulations-Monitoring bei wachen Patienten während Karotisendarteriektomie

Meeting Abstract

  • Julian Zipfel - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Martin U. Schuhmann - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Mario Lescan - Universitätsklinikum Tübingen, Klinik für Herz-/Thorax- und Gefäßchirurgie, Tübingen, Deutschland
  • presenting/speaker Sebastian Bantle - Universitätsklinikum Tübingen, Klinik für Herz-/Thorax- und Gefäßchirurgie, Tübingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP083

doi: 10.3205/20dgnc370, urn:nbn:de:0183-20dgnc3705

Published: June 26, 2020

© 2020 Zipfel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Carotid endarterectomy (CEA) is well-established for patients at risk for stroke with carotid artery disease. Selective shunting has been proposed with NIRS (Near-infrared spectroscopy) as a non-invasive tool for monitoring cerebrovascular autoregulation with the cerebral oximetry index (COx) and the hemoglobin volume index (HVx).

Methods: We performed NIRS in 59 consecutive patients, who underwent awake CEA. Regional SO2 and THb, as well as invasive arterial blood pressure were captured via ICM+ software (Cambridge Enterprise) and COx and HVx were calculated continuously. In case of neurological deterioration, a shunt was inserted.

Results: 6 of 51 (11.8%) patients needed intraoperative shunting. The drop in ipsilateral rSO2 was significantly larger in the shunt-group (5.31 vs. 13.50%) with increased contralateral values. ODA increased bilaterally, whilst significantly only on the non-operated side (1.62 to 1.678, p=0.056 vs. 1.63 to 1.68; p=0.016), In patients with neurological deficit during clamping no significant change in ODA during clamping was found, whereas in the patients without neurological deficit we detected a significant bilateral increase (1.59 to 1.65; p=0.022 vs. 1.60 to 1.66; p=0.01). In neurologically intact patients, COx decreased significantly on the operated side after clamping (0.18->0.12 (0.13, 0.02) p=0.024). In patients with deterioration of the neurological status, COx increased significantly (0.13 to 0.32±0.05; p=0.048). When pooling ipsi- and contralateral data, patients with neurological deficit showed a significant increase in HVx as compared to patients without deficit, where the trend was even negative (no shunt: 0.073 to 0.037 ±0.014) p=0.123, shunt: 0.05 vs 0.15 ±0.02) p<0.001). Comparable observation was made for COx (no shunt: COx 0.17 vs 0.10 (± 0.01) p=0.002, shunt: 0.18 vs 0.23±0.01; p=0.039).This autoregulation works up to mean arterial pressures of 110mmHg and higher, leading to impaired cerebrovascular reactivity contralaterally. When no shunt was needed, changes of autoregulation parameters remained non-significant.

Conclusion: Neurological deficit during awake CEA is associated with a significant decrease in ipsilateral rSO2 plus impaired contralateral autoregulation. Thus, the additional calculation of NIRS based autoregulation parameters makes it possible to identify patients, in whom a critical reduction of CBF has occurred. This is especially of importance, when general anesthesia is needed, and awake CEA is not possible.

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