ORIGINAL ARTICLES   

International Angiology 2004 December;23(4):388-93

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English

Contralateral stenosis as a risk factor for carotid endarterectomy measured by near infrared spectroscopy

Yamamoto K. ¹, Komiyama T. ¹, Miyata T. ¹, Kitagawa T. ¹, Momose T. ², Shigematsu H. ³, Nagawa H. ¹

¹ Unit of Vascular Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan 2 Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan 3 Surgical Center, University of Tokyo Hospital, Tokyo, Japan

Aim. It is still con­tro­ver­sial wheth­er the exis­tence of a con­tra­lat­er­al sten­o­sis is a risk fac­tor dur­ing carot­id endar­te­rec­to­my (CEA). We used a near ­infrared spec­tros­co­py (NIRS) mon­i­tor­ing ­system dur­ing CEA to eval­u­ate the hemo­dy­nam­ic ­effect of con­tra­lat­er­al sten­o­sis dur­ing cross clamp­ing of the carot­id arter­ies.
Meth­ods. We mon­i­tored 34 con­sec­u­tive cases of CEA, using NIRS. Tis­sue oxy­gen index (TOI), as a param­e­ter of oxy­gen­a­tion, and total hemo­glo­bin index (THI), as a param­e­ter of blood vol­ume, were meas­ured dur­ing cross-clamp­ing the carot­id arter­ies. We eval­u­at­ed the rela­tion­ship ­between these ­results and the pre- and intra­op­er­a­tive char­ac­ter­is­tics includ­ing the exis­tence of a con­tra­lat­er­al sten­o­sis and the ­results of sin­gle-pho­ton emis­sion com­put­ed tomog­ra­phy (SPECT).
­Results. Bilat­er­al TOI and THI cor­re­lat­ed well with the sever­ity of the sten­o­sis of the con­tra­lat­er­al inter­nal carot­id ­artery, and ipsi­lat­er­al THI cor­re­lat­ed with the cereb­ro­vas­cu­lar ­reserve meas­ured by SPECT.
Con­clu­sion. A con­tra­lat­er­al sten­o­sis is a risk fac­tor for CEA from the hemo­dy­nam­i­cal point of view, and ­extreme care ­should be taken when per­form­ing CEA in ­patients with bilat­er­al ste­nos­es.