Departments of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Curr Opin Anaesthesiol. 2011 Dec;24(6):693-7. doi: 10.1097/ACO.0b013e32834c7aa1.
The benefit of carotid endarterectomy (CEA) in patients with symptomatic severe carotid stenosis is highly dependent on the perioperative stroke rate. Cerebral monitoring plays an important role in reducing the perioperative stroke rate as it allows detection of the main causes of perioperative stroke, being embolism, intraoperative hypoperfusion and postoperative hyperperfusion syndrome. However, some physicians doubt about the benefit of cerebral monitoring and consider it costly and time consuming. The aim of this review is to provide an overview of the available cerebral monitoring modalities and their role in CEA.
Electroencephalography, transcranial Doppler, stump pressure and sensory-evoked potentials, are known and used for years. Near-infrared spectroscopy is a relatively new valuable technique, as it is noninvasive, easy to apply and applicable in all CEA patients, but remains to be validated.
In our opinion, cerebral monitoring during CEA is essential because it provides direct information regarding new neurological deficits, which might otherwise be missed. Intraoperative cerebral monitoring provides immediate feedback to the treating physician allowing prompt correction in tissue handling. Several monitoring modalities are available for cerebral monitoring in CEA, but no single test is comprehensive. Therefore, a combination of several monitoring modalities with each specific strength not only during but also after CEA is recommended to cover all needs and reduce the perioperative stroke rate.
颈动脉内膜切除术（CEA）在症状性严重颈动脉狭窄患者中的获益高度依赖于围手术期卒中发生率。脑监测在降低围手术期卒中率方面发挥着重要作用，因为它可以检测围手术期卒中的主要原因，即栓塞、术中低灌注和术后高灌注综合征。然而，一些医生对脑监测的益处表示怀疑，并认为其成本高且耗时。本文旨在提供脑监测方法的概述及其在 CEA 中的作用。
脑电图、经颅多普勒、残端压力和体感诱发电位已被广泛认知和应用多年。近红外光谱技术是一种相对较新的有价值的技术，因为它是非侵入性的，易于应用，适用于所有 CEA 患者，但仍有待验证。
我们认为，CEA 期间的脑监测至关重要，因为它可以提供有关新的神经功能缺损的直接信息，否则这些信息可能会被遗漏。术中脑监测为治疗医生提供即时反馈，允许及时纠正组织处理。有几种监测方法可用于 CEA 中的脑监测，但没有单一的测试是全面的。因此，建议在 CEA 期间和之后结合使用几种监测方法，每种方法都有其特定的优势，以满足所有需求并降低围手术期卒中率。
