Abstract:
BACKGROUND:To evaluate whether the preoperative magnetic resonance angiography (MRA) can predict the risk of cerebral ischemia associated with the carotid endarterectomy (CEA). METHODS:Between January 2004 and December 2010, 382 consecutive patients (mean age: 56.6 years; range: 45-78 years) were identified to have undergone preoperative MRA and the CEA under regional anesthesia. It was determined that the patient needs shunting during the CEA by intraoperative monitoring of patient's neurology. All patients were divided into two subgroups: shunt group or no-shunt group. Imaging findings on preoperative MRA were correlated to shunting using univariate and multivariate logistic regression analyses combined with patient's demographic and clinical features to identify predictors of cerebral ischemia during the CEA. RESULTS:In 37 of 382 CEA cases (9.7%), shunting had been performed intraoperatively because the patient had a neurologic deficit. At multivariate analysis, preoperative MRA findings such as the absence of patent communicating arteries (odds ratio [OR], 5.56; 95% confidence interval [CI], 3.05-9.69; p = 0.013) and the increase of intracranial arteries which were not patent in the contralateral hemisphere (OR, 4.277; 95% CI, 2.575 to 7.104; p < 0.0001) were significantly associated with shunting. CONCLUSIONS:Preoperative MRA is valuable when predicting cerebral ischemia leading to an inevitable shunting during CEA. Therefore, if there are preoperative MRA findings such as multiple occlusive intracranial arteries in the contralateral hemisphere or the absence of patent communicating arteries, it is recommended that CEA be performed under general anesthesia with routine shunting to avoid a serious shunt-related complication.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Shin S,Kwon TW,Cho YP,Shin JH,Yi A,Kim H,Kim GEdoi
10.1007/s00268-012-1851-2subject
Has Abstractpub_date
2013-03-01 00:00:00pages
663-70issue
3eissn
0364-2313issn
1432-2323journal_volume
37pub_type
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journal_title:World journal of surgery
pub_type: 杂志文章,评审
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pub_type: 杂志文章,评审
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journal_title:World journal of surgery
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pub_type: 临床试验,杂志文章,随机对照试验
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