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The Journal of Cardiovascular Surgery 2003 December;44(6):731-5

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Cerebral vasoreactivity does not predict cerebral ischaemia during carotid endarterectomy

Belardi P., Lucertini G.

Department of Vascular Surgery, University of Genoa, Genoa, Italy


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Aim. Assess­ment of cereb­ro­vas­o­reac­tivity (CVR), ­obtained by trans­cra­nial Dop­pler (TCD) and the acet­a­zol­a­mide ­test to pre­dict ­cases ­requiring selec­tive ­carotid ­shunting on the ­basis of neu­ro­logic mon­i­toring.
­Methods. A con­sec­u­tive ­series of 87 ­carotid endar­te­rec­tomy (CEA) ­cases was ­studied. ­Before sur­gery CVR was eval­u­ated by meas­uring the ­mean ­velocity of the ­middle cere­bral ­artery (­mvMCA) ­using TCD at the ­basal con­di­tion and at 30 min ­after intra­ve­nous admin­is­tra­tion of acet­a­zol­a­mide (1 g). ­Carotid ­shunting was per­formed ­using neu­ro­logic mon­i­toring ­under ­local anes­thesia. ­Receiver oper­ating char­ac­ter­istic (ROC) ­curve was cal­cu­lated for sen­si­tivity and spec­i­ficity for var­ious CVR cut ­offs.
­Results. The ROC ­curve dem­on­strated ­that ­there was no ­single CVR cut off ­with ­both sen­si­tivity and spec­i­ficity ­above 80%.
Con­clu­sion. The ­present ­study, ­which ­employed neu­ro­logic mon­i­toring as the ­method of com­par­ison, did not ­prove ­that CVR, as cal­cu­lated by TCD and the acet­a­zol­a­mide ­test, is a ­valid preoper­a­tive ­test for pre­dicting cere­bral ­ischaemia ­caused by ­carotid ­clamping.

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