ORIGINAL ARTICLES   

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)

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.