초록접수 현황
| 14F-106 | 구연 발표 |
Selective Carotid Shunting Based on Intraoperative Transcranial Doppler during Carotid Endarterectomy
장재석, 권오춘, 이섭, 전윤호
대구가톨릭대학교 의과대학 흉부외과학교실
Background : Neurological monitoring during carotid endarterectomy(CEA) is essential for carotid shunt placement. However, variable neurological monitoring techniques are available and none of the monitoring is perfect. And there is no clear evidence of routine shunting during CEA because of shunt-related devastating complication. This study aims to investigate our selective shunting strategy during CEA based on intraoperative transcranial doppler (TCD) monitoring and analyze risk factors of early postoperative neurologic complication.
Methods : We reviewed the medical records of 44 patients (mean age : 69.5±7.3 years, Male:Female=33:11) who underwent CEA from November 2009 to August 2014 at out center. Our strategy of intraoperative neurologic monitoring was TCD and we selectively used shunt in cases of poor temporal window or decrease of mean flow velocity under 30% of baseline flow.
Results : Preoperative atrial fibrillation was observed in 4 patients. Plaque ulceration was detected in 11 patients (24.4%) by preoperative CT imaging. High level stenosis (defined as stenosis above second Cervical spine) was observed in 16 patients (35.5%) and 18 patients had contralateral stenosis. 22 patients(50%) required shunt placement because of reduced TCD flow or poor temporal window. In patients without shunt placement, mean TCD flow velocity after clamping was 69.8% of baseline. 30-day mortality rate was 2.2% and cause of death was postoperative pneumonia. There was 3 cases (6.6%) of 30-day stroke and all cases were recorvered without disabling sequelae. Univariate analysis showed that preoperative atrial fibrillation was the only statistically significant (OR=4.0; P<0.001) risk factor for 30-day stroke. In Multivariate analysis, 30-day stroke rate was not significantly different in terms of shunt placement.
Conclusion : Intraoperative TCD monitoring-based selective shunting rather than routine shunting during CEA was feasible for cerebral protection.
Methods : We reviewed the medical records of 44 patients (mean age : 69.5±7.3 years, Male:Female=33:11) who underwent CEA from November 2009 to August 2014 at out center. Our strategy of intraoperative neurologic monitoring was TCD and we selectively used shunt in cases of poor temporal window or decrease of mean flow velocity under 30% of baseline flow.
Results : Preoperative atrial fibrillation was observed in 4 patients. Plaque ulceration was detected in 11 patients (24.4%) by preoperative CT imaging. High level stenosis (defined as stenosis above second Cervical spine) was observed in 16 patients (35.5%) and 18 patients had contralateral stenosis. 22 patients(50%) required shunt placement because of reduced TCD flow or poor temporal window. In patients without shunt placement, mean TCD flow velocity after clamping was 69.8% of baseline. 30-day mortality rate was 2.2% and cause of death was postoperative pneumonia. There was 3 cases (6.6%) of 30-day stroke and all cases were recorvered without disabling sequelae. Univariate analysis showed that preoperative atrial fibrillation was the only statistically significant (OR=4.0; P<0.001) risk factor for 30-day stroke. In Multivariate analysis, 30-day stroke rate was not significantly different in terms of shunt placement.
Conclusion : Intraoperative TCD monitoring-based selective shunting rather than routine shunting during CEA was feasible for cerebral protection.
책임저자: 권오춘
대구가톨릭대학교 의과대학 흉부외과학교실
연락처 : 장재석, Tel: 053-650-4566 , E-mail : medi79@naver.com
