초록접수 현황
| 16F-003 | 구연 발표 |
The Benefits of NIRS Compared with TCD-based Monitoring in Carotid Endarterectomy Regarding Perioperative Concerns
Jun Woo Cho, Oh Choon Kwon
Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University Medical Center, Daegu Catholic University College of Medicine, Daegu, Korea
Background : A proper monitoring during carotid artery surgery can provide us an exact state of cerebral perfusion which reflects the need of shunt. We evaluated benefits of Near-infrared spectroscopy(NIRS) which is now a substitute for traditional methods of cerebral monitoring.
Methods : This single center, retrospective review was conducted with the patients who underwent CEA using selective shunt based on TCD or NIRS at Daegu Catholic University Medical Center, from November 2009 to June 2016. TCD group and NIRS group were compared in terms of postoperative complications. Additionally univariable and multivariable analysis were performed to assessed the relation between postoperative stroke and risk factors including hypertension, diabetes mellitus, hyperlipidemia, symptom appearance or not, hyperlipidemia, coronary artery disease, current smoker, ex-smoker, current alcohol user, ulcerative lesions on carotid artery, contra-lateral lesion, high level lesion(stenosis above the second cervical spine), atrial fibrillation, operative time, shunting use or not, and operative side.
Results : Total 74 patients are enrolled in this study(TCD group 45, NIRS group 29). Demographic characteristics are not different between two groups. There is only one patient of postoperative 30-day mortality in TCD group. Postoperative stroke was reported 4 cases in TCD group, but no one had stroke postoperatively in NIRS group(P-value 0.15). Postoperative neurologic complications presenting headache, exacerbated pre-existing symptoms, peripheral neuropathy, and dizziness which are not related to postoperative stroke were reported 7 cases only in TCD group (P-value 0.005). Shunt usage was as high as 44.4% in TCD group, by contrast 10.3% in NIRS group (P-value 0.002). Ex-smoker and atrial fibrillation were proved as risk factors for postoperative stroke in univariable analysis, but not in multivariable.
Conclusion : Using NIRS during CEA is a reliable and convenient method to monitoring cerebral perfusion in terms of preventing postoperative stroke and other neurologic complications. It can also reduce the unnecessary shunt usage.
Methods : This single center, retrospective review was conducted with the patients who underwent CEA using selective shunt based on TCD or NIRS at Daegu Catholic University Medical Center, from November 2009 to June 2016. TCD group and NIRS group were compared in terms of postoperative complications. Additionally univariable and multivariable analysis were performed to assessed the relation between postoperative stroke and risk factors including hypertension, diabetes mellitus, hyperlipidemia, symptom appearance or not, hyperlipidemia, coronary artery disease, current smoker, ex-smoker, current alcohol user, ulcerative lesions on carotid artery, contra-lateral lesion, high level lesion(stenosis above the second cervical spine), atrial fibrillation, operative time, shunting use or not, and operative side.
Results : Total 74 patients are enrolled in this study(TCD group 45, NIRS group 29). Demographic characteristics are not different between two groups. There is only one patient of postoperative 30-day mortality in TCD group. Postoperative stroke was reported 4 cases in TCD group, but no one had stroke postoperatively in NIRS group(P-value 0.15). Postoperative neurologic complications presenting headache, exacerbated pre-existing symptoms, peripheral neuropathy, and dizziness which are not related to postoperative stroke were reported 7 cases only in TCD group (P-value 0.005). Shunt usage was as high as 44.4% in TCD group, by contrast 10.3% in NIRS group (P-value 0.002). Ex-smoker and atrial fibrillation were proved as risk factors for postoperative stroke in univariable analysis, but not in multivariable.
Conclusion : Using NIRS during CEA is a reliable and convenient method to monitoring cerebral perfusion in terms of preventing postoperative stroke and other neurologic complications. It can also reduce the unnecessary shunt usage.
책임저자: Oh Choon Kwon
Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University Medical Center, Daegu Catholic University College of Medicine, Daegu, Korea
발표자: Jun Woo Cho, E-mail : jojunwu@hanmail.net