Leopardi Marco, Musilli Aldo, Piccolo Elisa, Marrelli Alfonso, Martinazzo Claudio, Maggipinto Annamaria, Ventura Marco
Vascular Surgery Unit, Department of Vascular Surgery, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
Vascular Surgery Unit, Department of Vascular Surgery, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
Ann Vasc Surg. 2019 Nov;61:178-184. doi: 10.1016/j.avsg.2019.04.017. Epub 2019 Jul 20.
The use of shunt during carotid surgery is controversial. Different experiences are found in literature with transcranial Doppler (TCD), electroencephalogram (EEG), stump pressure (SP), and somatosensorial evoked potentials (SSEP).
We realized a retrospective analysis of patients treated with carotid endarterectomy in our unit in the last 2 years. We use several cerebral monitoring: until 2017 we preferred SP + TCD, and, if not available, EEG. Since 2017 we introduced EEG with SSEP, always in association with SP. We analyzed those 2 groups of patients: before and after introduction of EEG with SSEP.
From January 2016 to December 2018 we performed 156 carotid revascularizations. In the first group of 93 patients treated under combined SP + TCD (or EEG), we observed 1 stroke (1.1%) and 2 transient ischemic attacks (TIAs) (2.1%); we selectively used a shunt in 21 cases (22.5%). In the second group, 63 patients had an SP + EEG with SSEP monitoring; we observed 1 stroke (1.5%) and 2 TIAs (3.1%), a shunt was necessary in 12 cases (12.9%).
In our experience, EEG with SSEP represents an effective parameter to indicate shunt positioning, as we were able to reduce its use, with the same incidence of stroke and TIA.
颈动脉手术中分流术的使用存在争议。文献中关于经颅多普勒（TCD）、脑电图（EEG）、残端压力（SP）和体感诱发电位（SSEP）有不同的经验。
我们对本单位过去2年接受颈动脉内膜切除术的患者进行了回顾性分析。我们采用了几种脑监测方法：直到2017年，我们更倾向于使用SP + TCD，如果无法使用，则使用EEG。自2017年以来，我们引入了EEG与SSEP联合使用，且始终与SP联合。我们分析了这两组患者：引入EEG与SSEP之前和之后的患者。
2016年1月至2018年12月，我们进行了156例颈动脉血运重建术。在第一组93例接受SP + TCD（或EEG）联合治疗的患者中，我们观察到1例中风（1.1%）和2例短暂性脑缺血发作（TIA）（2.1%）；我们在21例（22.5%）患者中选择性地使用了分流术。在第二组中，63例患者接受了SP + EEG与SSEP监测；我们观察到1例中风（1.5%）和2例TIA（3.1%），12例（12.9%）患者需要使用分流术。
根据我们的经验，EEG与SSEP是指示分流术定位的有效参数，因为我们能够减少其使用，同时中风和TIA的发生率相同。
