Ballotta Enzo, Saladini Marina, Gruppo Mario, Mazzalai Franco, Da Giau Giuseppe, Baracchini Claudio
Vascular Surgery Section, Geriatric Surgery Clinic, Department of Surgical and Gastroenterological Sciences, School of Medicine, University of Padua, Padua, Italy.
Ann Vasc Surg. 2010 Nov;24(8):1045-52. doi: 10.1016/j.avsg.2010.06.005.
Carotid endarterectomy (CEA) is associated with a risk of cerebral ischemia during carotid clamping, hence various cerebral protection strategies, including pharmacological management and routine or selective shunting, are commonly available. This study aimed to analyze the results of CEA with intraoperative electroencephalographic (EEG) monitoring to identify factors associated with EEG changes consistent with cerebral ischemia which needed shunting.
A prospectively compiled, computerized database of all primary CEAs performed at our institution with EEG monitoring for symptomatic or asymptomatic severe carotid lesions between January 1990 and June 2009 was analyzed.
In all, 1,914 CEA procedures were performed on 1,696 patients, of which 218 had staged bilateral CEAs. EEG changes were recorded in 392 patients (20.5%), but a shunt was inserted during 312 CEA procedures (16.3%). Multivariate analysis showed that a symptomatic presentation (odds ratio [OR], 1.37; 95% confidence intervals [CI], 1.07-1.76; p = 0.012), prior stroke (OR, 2.28; 95% CI, 1.66-3.13; p < 0.001), contralateral carotid occlusion (OR, 2.14; 95% CI, 1.18-3.91; p = 0.019), and moderate (<80%) ipsilateral carotid disease (OR, 1.95; 95% CI, 1.08-3.52; p = 0.033) predicted the need for shunting.
EEG was an excellent detector of cerebral ischemia and a valuable tool in guiding the need for shunting. Patients who were symptomatic or had a history of stroke, a contralateral carotid occlusion, or an ipsilateral moderate carotid stenosis were more prone to EEG changes consistent with cerebral ischemia. Surgeons should consider EEG changes during clamping as an effective criterion for selective shunting.
颈动脉内膜切除术（CEA）与颈动脉夹闭期间发生脑缺血的风险相关，因此，包括药物治疗以及常规或选择性分流术在内的各种脑保护策略普遍可用。本研究旨在分析术中脑电图（EEG）监测下CEA的结果，以确定与需要分流的、符合脑缺血的EEG变化相关的因素。
分析了1990年1月至2009年6月在本机构对有症状或无症状的严重颈动脉病变进行EEG监测的所有原发性CEA的前瞻性汇编计算机数据库。
共对1696例患者进行了1914例CEA手术，其中218例为分期双侧CEA。392例患者（20.5%）记录到EEG变化，但在312例CEA手术（16.3%）中插入了分流管。多因素分析显示，有症状表现（比值比[OR]，1.37；95%置信区间[CI]，1.07 - 1.76；p = 0.012）、既往中风（OR，2.28；95%CI，1.66 - 3.13；p < 0.001）、对侧颈动脉闭塞（OR，2.14；95%CI，1.18 - 3.91；p = 0.019）以及同侧颈动脉中度病变（<80%）（OR，1.95；95%CI，1.08 - 3.52；p = 0.033）预示需要分流。
EEG是脑缺血的优秀检测手段，也是指导是否需要分流的宝贵工具。有症状或有中风病史、对侧颈动脉闭塞或同侧中度颈动脉狭窄的患者更容易出现符合脑缺血的EEG变化。外科医生应将夹闭期间的EEG变化视为选择性分流的有效标准。
