Ucci Alessandro, D'Ospina Rita Maria, Fanelli Mara, Rossi Giulia, Persi Federica, Bridelli Franca, Tosi Michela, Bianchini Massoni Claudio, Perini Paolo, Nabulsi Bilal, De Troia Alessandro, Tecchio Tiziano, Azzarone Matteo, Freyrie Antonio
Vascular Surgery, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
Anaesthesiology, Intensive Care and Pain Therapy, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Parma, Italy.
Acta Biomed. 2018 Mar 27;89(1):61-66. doi: 10.23750/abm.v89i1.6814.
We report 1-year single-centre experience in carotid endarterectomy (CEA) combining general anaesthesia with preserved consciousness (GAPC) and standardized carotid sequential cross-clamping, for our protocol effectiveness evaluation in reduction of perioperative stroke, death or cardiologic complications.
We considered all patients who underwent CEA in 2016. All patients underwent superficial cervical plexus block and GAPC with Remifentanil. The surgical technique consisted of common carotid artery (CCA) cross-clamping, carotid bifurcation isolation, external (ECA) and internal carotid artery (ICA) cross-clamping. After CCA cross-clamping, we performed a neurological tolerance test (NTT); this allowed selective shunting only for positive NTT. Primary end-points were: transient ischemic attack (TIA)/stroke, myocardial infarction, death in perioperative period. Secondary end-points were: carotid shunting, peripheral cranial nerves injuries (PCNI), GAPC intolerance, other complications, reintervention in perioperative period, length of hospital stay.
104 consecutive patients underwent CEA with this protocol in the considered period. Twenty-seven (25.9%) patients were symptomatic. Mean clamping time was 48±13.5 minutes. Five cases (4.8%) requested internal carotid artery shunting. No TIA/stroke, myocardial infarction or death were recorded in the perioperative period. PCNI were observed in 19 cases (18.2%) in the immediate post-operative period; 16 of them (84.2%) showed complete or partial resolution at discharge. Only one patient (0.9%) showed GAPC intolerance. No other complication occurred. Three patients (2.9%) underwent reintervention for neck haematoma drainage. Mean hospital stay were 3±0.9 days.
GAPC associated with sequential carotid cross-clamping appeared to be safe and effective in prevention of major neurological and cardiologic complications during CEA.
我们报告了在颈动脉内膜切除术（CEA）中采用全身麻醉并保留意识（GAPC）以及标准化颈动脉序贯交叉钳夹技术的单中心1年经验，以评估我们的方案在降低围手术期卒中、死亡或心脏并发症方面的有效性。
我们纳入了2016年接受CEA的所有患者。所有患者均接受颈浅丛阻滞和使用瑞芬太尼的GAPC。手术技术包括颈总动脉（CCA）交叉钳夹、颈动脉分叉分离、颈外动脉（ECA）和颈内动脉（ICA）交叉钳夹。在CCA交叉钳夹后，我们进行了神经耐受性测试（NTT）；这使得仅在NTT结果为阳性时才进行选择性分流。主要终点为：短暂性脑缺血发作（TIA）/卒中、心肌梗死、围手术期死亡。次要终点为：颈动脉分流、周围颅神经损伤（PCNI）、GAPC不耐受、其他并发症、围手术期再次干预、住院时间。
在研究期间，104例连续患者按照该方案接受了CEA。27例（25.9%）患者有症状。平均钳夹时间为48±13.5分钟。5例（4.8%）患者需要进行颈内动脉分流。围手术期未记录到TIA/卒中、心肌梗死或死亡。术后即刻观察到19例（18.2%）发生PCNI；其中16例（84.2%）在出院时显示完全或部分缓解。仅1例患者（0.9%）表现出GAPC不耐受。未发生其他并发症。3例患者（2.9%）因颈部血肿引流而接受再次干预。平均住院时间为3±0.9天。
GAPC联合颈动脉序贯交叉钳夹在预防CEA期间的主要神经和心脏并发症方面似乎是安全有效的。
