Vol. 20 No. 2 (2016)
VASCULAR SURGERY

The prognostic value of cerebral oxygenation and retrograde pressure during carotid endarterectomy

PDF (Русский)
  • A. Karpenko,
  • R. Kuzhuget,
  • O. Kamenskaya,
  • P. Ignatenko,
  • V. Starodubtsev,
  • A. Shilova
A. Karpenko
Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk
Bio
R. Kuzhuget
Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk
Bio
O. Kamenskaya
Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk
P. Ignatenko
Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk
V. Starodubtsev
Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk
A. Shilova
Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk
DOI: https://doi.org/10.21688/1681-3472-2016-2-95-103

Published 2016-08-17

Keywords

  • carotid endarterectomy,
  • cerebral oxygenation,
  • retrograde pressure,
  • S-100 protein,
  • neuron specific enolase.

How to Cite

Karpenko, A., Kuzhuget, R., Kamenskaya, O., Ignatenko, P., Starodubtsev, V., & Shilova, A. (2016). The prognostic value of cerebral oxygenation and retrograde pressure during carotid endarterectomy. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 20(2), 95–103. https://doi.org/10.21688/1681-3472-2016-2-95-103

Copyright (c) 2016 Karpenko A.A., Kuzhuget R.А., Kamenskaya O.V., Ignatenko P.V., Starodubtsev V.B., Shilova A.N.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Aim: The study aimed to determine the predictive value of retrograde pressure (RP) indicators and cerebral oxygenation in the evaluation of ischemic brain damage during carotid endarterectomy (CEA).
Methods: This nonrandomized, prospective pilot study included 87 patients with asymptomatic stenosis greater than 70% who underwent carotid endarterectomy under general anesthesia. Brain tolerance to ischemia was determined by measuring and evaluating RP (∆rSO2) and cerebral oxygenation (rSO2) during a trial clamping of the carotid artery. Depending on the degree of reduction of cerebral oxygenation from the baseline (∆rSO2) during a trial clamping of the carotid artery, patients were divided into 3 groups: the first group (n = 35) - ∆rSO2 <9.9%, the second group (n = 35) - ∆rSO2 from 10 to 19.9%, the third group (n = 14) - ∆rSO2 ≥ 20%. The primary end-point of the study was to obtain the AUC value exceeding 0.70, which could mean a high predictive quality of research methods.
Results: There were no perioperative strokes or myocardial infarctions during the study. Average time of carotid artery clamping was 28 (26-30) minutes. 3 patients who received temporary shunts were excluded from the study because of a simultaneous decrease in the rSO2 and ∆rSO2 indicators. It was found out that S-100 and NSE protein concentration in all groups did not significantly differ at different stages (p> 0.05). A temporary shutdown of blood flow in the carotid artery during CEA is accompanied by significant elevation of cerebral damage markers (S100, NSE) concentration with their subsequent restoration at 3 days after surgery. ROC - analysis revealed that none of the methods for assessing cerebral ischemic tolerance (RP, ∆rSO2 and rSO2) is precise enough (AUC > 0.7) to predict brain injury during carotid endarterectomy. Satisfactory, but a poor quality (AUC< 0.7) of predicting an increase in the reference values of S-100 protein neuromarkers was demonstrated by retrograde pressure, while the other indicators (∆rSO2 and rSO2) did not exceed the area under the curve (AUC) over 0.60.
Conclusion: Methods of measuring retrograde pressure and cerebral oxygenation are merely a reflection of the collateral blood flow and the cerebral oxygenation level due to their close relationship, but they cannot be used as predictors of ischemic neuronal damage during carotid endarterectomy because of poor predictive quality.

PDF (Русский)

References

  1. Gosling RG, Budge MM. Terminology for describing the elastic behavior of arteries. Hypertensio 2003;41(6):1180-2.
  2. Ishihara H, Sugo Y, Tsutsui M, Yamada T, Sato T, Akazawa T, Sato N, Yamashita K, Takeda J. The ability of a new continuous cardiac output monitor to measure trends in cardiac output following implementation of a patient information calibration and an automated exclusion algorithm. J Clin Monit Comput. 2012;26(6):465-71. http://dx.doi.org/10.1007/s10877-012-9384-7
  3. Critchley LA, Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. J Clin Monit Comput. 1999;15(2):85-91.
  4. Critchley LA, Yang XX, Lee A. Assessment of trending ability of cardiac output monitors by polar plot methodology. J Cardiothorac Vasc Anesth. 2011;25(3):536-46. http://dx.doi.org/10.1053/j.jvca.2011.01.003
  5. Peyton PJ, Chong SW. Minimally invasive measurement of cardiac output during surgery and critical care: a meta-analysis of accuracy and precision. 2010;113(5): 1220-35. http://dx.doi.org/10.1097/ALN.0b013e3181ee3130
  6. Sharwood-Smith G, Bruce J, Drummond G. Assessment of pulse transit time to indicate cardiovascular changes during obstetric spinal anaesthesia. Br J Anaesth. 2006;96(1):100-5.
  7. Bataille B, Bertuit M, Mora M, Mazerolles M, Cocquet P, Masson B, Moussot PE, Ginot J, Silva S, Larché J. Comparison of esCCO and transthoracic echocardiography for non-invasive measurement of cardiac output intensive care. Br J Anaesth. 2012;109(6):879-86. http://dx.doi.org/10.1093/bja/aes298
  8. Sinha AC, Singh PM, Grewal N, Aman M, Dubowitz G. Comparison between continuous non-invasive estimated cardiac output by pulse wave transit time and thermodilution method. Ann Card Anaesth. 2014;17(4):273-7. http://dx.doi.org/10.4103/0971-9784.142059
  9. Fischer MO, Balaire X, Le Mauff de Kergal C, Boisselier C, Gérard JL, Hanouz JL, Fellahi JL. The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography. Can J Anaesth. 2014;61(1):19-26. http://dx.doi.org/10.1007/s12630-013-0055-z
  10. Sugo Y, Sakai T, Terao M, Ukawa T, Ochiai R. The comparison of a novel continuous cardiac output monitor based on pulse wave transit time and echo Doppler during exercise. Conf Proc IEEE Eng Med Biol So 2012;2012:236-9. http://dx.doi.org/10.1109/EMBC.2012.6345913
  11. Biancofiore G, Critchley LA, Lee A, Bindi L, Bisà M, Esposito M, Meacci L, Mozzo R, DeSimone P, Urbani L, Filipponi F. Evaluation of an uncalibrated arterial pulse contour cardiac output monitoring system in cirrhotic patients undergoing liver surgery. J. Anaesth. 2009;102(1):47-54. http://dx.doi.org/10.1093/bja/aen343
  12. Ishihara H, Tsutsui M. Impact of changes in systemic vascular resistance on a novel non-invasive continuous cardiac output measurement system based on pulse wave transit time: a report of two cases. J Clin Monit Comput. 2014;28(4):423-7. http://dx.doi.org/10.1007/s10877-013-9529-3
  13. Maeda T, Yoshitani K, Inatomi Y, Ohnishi Y. Inaccuracy of the FloTrac/Vigileo™ system in patients with low cardiac index. J Cardiothorac Vasc Anesth. 2014;28(6):1521-6. http://dx.doi.org/10.1053/j.jvca.2014.04.013
  14. Mayer J, Boldt J, Schöllhorn T, Röhm KD, Mengistu AM, Suttner S. Semi-invasive monitoring of cardiac output by a new device using arterial pressure waveform analysis: a comparison with intermittent pulmonary artery thermodilution in patients undergoing cardiac surgery. Br J Anaesth. 2007;98(2):176-82.
  15. Ribezzo S, Spina E, Di Bartolomeo S, Sanson G. Noninvasive techniques for blood pressure measurement are not a reliable alternative to direct measurement: a randomized crossover trial in ICU. Scientific World Journal. 2014;2014: http://dx.doi.org/10.1155/2014/353628