Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-23T20:40:26.250Z Has data issue: false hasContentIssue false
  • English
  • Français

Intraoperative Regional Cerebral Blood Flow During Carotid Endarterectomy

Published online by Cambridge University Press:  18 September 2015

David W. Rowed  and
Miklos I. Vilaghy
David W. Rowed*
Affiliation:
Divisions of Neurosurgery and Neurology, Sunnybrook Medical Centre, University of Toronto
Miklos I. Vilaghy
Affiliation:
Divisions of Neurosurgery and Neurology, Sunnybrook Medical Centre, University of Toronto
*
Division of Neurosurgery, Room 4037, Sunnybrook Medical Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5
Rights & Permissions [Opens in a new window]

Summary:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Regional cerebral blood flow (rCBF) during internal carotid artery (ICA) occlusion for endarterectomy can be measured without inconvenience using the probe holder illustrated.

When mean ipsilateral hemispheric CBF exceeds 20 ml/100 gm/min, an intraluminal bypass is not necessary (63% of patients), except in patients with extensive cerebrovascular disease in whom rCBF should also exceed 20 ml/100 gm/min in all areas. ICA “stump” pressure is falsely high in about 20% of patients, and is therefore not a dependable criterion for selecting patients who need shunting.

While intraoperative shunting is capable of restoring pre-occlusion CBF levels, it does not eliminate the risk of intraoperative ischemic neurological deficit of probable embolic origin.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 8 , Issue 3 , August 1981 , pp. 235 - 241
Copyright
Copyright © Canadian Neurological Sciences Federation 1981

References

REFERENCES

Boysen, G., (1973). Cerebral hemodynamics in carotid surgery. Acta Neurol. Scand 49: Supp 52: 46.Google Scholar
Benoit, B.G., Nabavi, N.X., (1978). The “routine” use of intraluminal shunting in carotid endarterectomy. Can. J. Neurol. Sci. 5: 339.Google Scholar
Chiappa, D.H.Burke, S.R.Young, R. R., (1979). Results of electroencephalographic monitoring during 367 carotid endarterectomies. Use of a dedicated minicomputer. Stroke 10: 381–388.CrossRefGoogle ScholarPubMed
Eastcott, H.H.G., Pickering, G.W., (1954). Reconstruction of internal carotid artery in a patient with intermittent attacks of hemiplegia. Lancet ii: 994–996.Google Scholar
Fields, W.S., Maslenikov, V., Meyer, J.S., et al (1970). Joint Study of extracranial arterial occlusion V. Progress report of prognosis following surgery or nonsurgical treatment for transsient cerebral ischemic attacks and cervical carotid artery lesions. JAMA 211: 1993–2003.CrossRefGoogle ScholarPubMed
Ferguson, G.G., Blume, W.T.McNeill, K., et al (1978). Carotid endarterectomy: Is an internal shunt really necessary? Can. J. Neurol. Sci.: 340Google Scholar
Hays, R.J., Levinson, S.A.Wylie, E.J., (1972). Intraoperative measurement of carotid back pressure as a guide to operative management for carotid endarterectomy. Surgery 72: 953–960.Google ScholarPubMed
Olesen, J., (1974). Cerebral blood now. Methods for measurement, regulating affects of drugs and changes in disease, pp 11–18, Fadl’s Forlag, Copenhagen.Google Scholar
Sundt, T.M., Sandok, B.A., Whisnant, J.P., (1975). Carotid endarterectomy. Complications and preoperative assessment of risk. Mayo Clinic Proc 50: 301–306.Google ScholarPubMed
Sundt, T.M., Sharbrough, F.W., Anderson, R.E., et al (1974). Cerebral blood flow measurements and electroencephalograms during carotid endarterectomy. J. Neurosurg 41: 310–320.Google ScholarPubMed
Sublett, J.W., Seidenberg, A.B., Hobson, R.W., (1974). Internal carotid artery stump pressures during regional anesthesia. Anesthesiology 41: 505–508.CrossRefGoogle ScholarPubMed
West, H., Burton, R., Roon, A.J., et al (1979). Comparative risk of operation and expectant management for carotid artery disease. Stroke 10: 117–121.CrossRefGoogle ScholarPubMed