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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2014 Jun 11

language: English

Clinical validation of carotid stump pressure (40 mm hg.) for patients undergoing carotid endarterectomy under general anesthesia

Shahidi S. 1, Owen-Falkenberg A. 2, Ghotthschalksen B. 1

1 Department of Vascular Surgery, Regional Hospital Slagelse, Region Zealand, Denmark;
2 Department of Anesthesiology, Regional Hospital Slagelse, Region Zealand, Denmark


PURPOSE: The aim of this study was to validate a Stump Pressure(SP) of 40 mmHg(mean) as the cut off threshold for shunting during carotid endarterectomy (CEA).
METHODS: A prospective analysis of recently symptomatic carotid stenosis patients undergoing CEA (Fast Track) under GA. An arbitrary cut-off threshold of 40 mm Hg (mean) was defined as the indication for shunt insertion. With an SP < 40 mmHg systemic blood pressure was increased 10-20% using sympathomimetic drugs. Patients with an SP ≥ 40 mmHg CEA were operated without a shunt. A neurological observation scheme was filled out preoperatively by the anesthesiologist and postoperatively during the first 24 hours after surgery. Endpoints for validation of SP were per new TIA or stroke (ipsilateral or contralateral), hypoperfusion/hypoxia syndrome or death before discharge from hospital.
RESULTS: 120 consecutive CEA's were performed in recently symptomatic patients. A significant correlation between SP and the contralateral stenosis degree of ICA was found in our study p = 0,05. Sixteen patients (14%) had SP < 40 mmHg after clamping the carotid arteries. Raising blood pressure intra-operatively by 10-20% reduced the incidence of shunt insertion to only three patients( 80% reduction). Of the 120 CEA`s only 2.5% (CI 95% 1-6%) of patients required shunt. There was no post-operative TIA or stroke in our study. Two patients (1.65%) suffered early TIA from ipsilateral ICA after discharge from the vascular unit.
CONCLUSION: Using an SP of 40 mmHg (mean) as a threshold seems to be a safe, easy and cheap method for selective shunt insertion in fast track CEA under general anesthesia with a zero false-negative rate. Raising the systemic blood pressure by 10-20%during cross clamping increased SP above the threshold value 40 mmHg thus avoiding shunt insertion in a number of patients.

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