DeLaurentis D A, Dougherty M J, Calligaro K D, Savarese R P, Raviola C A, Bajgier S M
Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia.
Am J Surg. 1993 Aug;166(2):152-5; discussion 155-6. doi: 10.1016/s0002-9610(05)81047-5.
In order to obtain a more comprehensive intraoperative hemodynamic profile and to predict hypoperfusion during carotid endarterectomy, stump pressure, stump pulse, and retrograde internal carotid flow were measured in 261 patients. Our results show a significant correlation between stump pressure and retrograde flow (p < 0.001), stump pressure and the presence of a stump pulse (p < 0.001), and retrograde flow and the presence of a stump pulse (p < 0.001). We also demonstrated a significant correlation between stump pressure (lower), retrograde flow (less), and the absence of a stump pulse in patients with contralateral carotid artery occlusion. There was no correlation between the indication for carotid endarterectomy and any hemodynamic measurement. The triad of stump pulse, stump pressure, and retrograde flow accurately reflects collateral blood flow when the carotid is cross-clamped. These determinations can be obtained at low cost and are easily and rapidly performed. A protocol for selective shunting in patients undergoing carotid endarterectomy with general anesthesia is suggested.
