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Journal of Neurosurgical Sciences 2001 September;45(3):157-62

Copyright © 2001 EDIZIONI MINERVA MEDICA

lingua: Inglese

Propofol EEG burst suppression in carotid endarterectomy

D’Angelo V. 1, Catapano G. 1, Bozzini V. 1, Catapano D. 1, De Vivo P. 2, Del Gaudio A. 2, Ciritella P. 2, Simone P. 3

1 Department of Neurosurgery, “Casa Sollievo della Sofferenza” Hospital, IRCCS, San Giovanni Rotondo (FG); 2 II Department of Anesthesiology and Intensive Care Unit, “Casa Sollievo della Sofferenza” Hospital, IRCCS, San Giovanni Rotondo (FG); 3 Department of Neurology, “Casa Sollievo della Sofferenza” Hospital, IRCCS, San Giovanni Rotondo (FG)


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Background. The ­results of ran­dom­ized ­trials indi­cate ­that carot­id endar­te­rec­to­my, per­formed ­with a low mor­bid­ity-mor­tal­ity per­i­op­er­a­tive ­risk, is ­the ­best ther­a­peu­tic ­option ­both for ­patients ­with ­high-­grade symp­to­mat­ic and asymp­to­mat­ic sten­o­sis. Since the ­main oper­a­tive ­risk is rep­re­sent­ed by embol­ic or hemo­dy­nam­ic cere­bral ische­mia, it ­appears nec­es­sary to main­tain an ade­quate intra­op­er­a­tive cere­bral ­blood ­flow and to car­ry out a metic­u­lous endar­te­rec­to­my.
Methods. On the ­basis of ­these con­sid­er­a­tions we pros­pec­tive­ly stud­ied a ­series of 100 con­sec­u­tive ­patients oper­at­ed on for ­high-­grade carot­id sten­o­sis, by ­using a pro­to­col ­based on: 1) an accu­rate selec­tion of ­patients for sur­gery; 2) metic­u­lous sur­gi­cal tec­nique with­out any ­shunt; 3) per­i­op­er­a­tive cere­bral pro­tec­tion by bar­bit­u­rate or pro­pof­ol; 4) pre- and post­op­er­a­tive med­i­cal treat­ment of ­risk fac­tors. All ­patients of our ­series per­formed pre­op­er­a­tive­ly ­brain CT ­scan, trans­cra­ni­al Doppler, carot­id ­duplex scan­ning, ­four ves­sel angio­gra­phy, ­brain 99mTc-­HMPAO ­SPECT. Eighty-two ­patients had symp­to­mat­ic carot­id sten­o­sis ­ranged ­between 70 and 90%, 18 had carot­id sten­o­sis high­er ­than 90%.
Results. In ­this ­series ­there ­have ­been one post­op­er­a­tive ­death due to myo­car­dial infarc­tion and one ­major ­stroke.
Conclusions. We ­think ­that ­this pro­to­col can sig­nif­i­cant­ly min­i­mize ­risks of endar­te­rec­to­my and prob­ably max­imize the ben­e­fits of sur­gery, ­also in ­patients ­with asymp­to­mat­ic ­high-­grade carot­id sten­o­sis.

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