Authors: Lam J. M. K.¹; Smielewski P.¹; Al-Rawi P.¹; Griffiths P.²; Yu A. L. M.³; Pickard J. D.¹; Kirkpatrick P. J.¹

Source: British Journal of Neurosurgery, Volume 14, Number 5, 1 October 2000 , pp. 441-448(8)

Publisher: Informa Healthcare

Abstract:

The objective of this study was to assess the value of combining the preoperative CO₂ cerebrovascular reactivity index (CO₂RI) with carotid and cerebral angiography in predicting the risk of severe cerebral ischaemia (SCI) during carotid endarterectomy (CEA). Seventy-four consecutive patients scheduled for CEA underwent preoperative digital subtraction angiography and CO₂-reactivity tests. During CEA, cerebral function monitor (CFM) was used to document cortical electrical activity, whilst transcranial Doppler measured the middle cerebral artery flow velocity (FV). A persistent fall in CFM voltage and/or a fall in FV 60% on internal carotid artery (ICA) clamping were used as criteria for defining SCI. Complete data from 59 patients were obtained for final analysis. Twelve cases showed a fall in FV 60%; 11 of these also showed a sustained fall in CFM voltage. Using logistic regression, the risk of SCI was found to be negatively associated with (1) contralateral CO₂RI, (2) the percentage stenosis of the contralateral ICA, and (3) the difference between ipsilateral and contralateral CO₂RI. Using these factors, a logistic regression model for predicting the risk of SCI was established which provided a sensitivity of 75% and specificity of 100%. The risk of SCI during CEA was related to the contralateral ICA stenosis and the CO₂RI of both cerebral hemispheres. This information may assist in presurgical planning and help to select asymptomatic carotid lesions for surgery.

Keywords: CARBON DIOXIDE REACTIVITY; CAROTID ENDARTERECTOMY; CAROTID OCCLUSIVE DISEASE; CEREBRAL HAEMODYNAMICS; CEREBRAL ISCHAEMIA; TRANSCRANIAL DOPPLER

Language: English

Document Type: Research article

Affiliations: 1: MRC Cambridge Centre for Brain Repair & Academic Neurosurgical Unit, Addenbrooke"s Hospital, Cambridge, UK 2: Department of Radiology, Addenbrooke"s Hospital, Cambridge, UK 3: Centre for Clinical Trial and Epidemiological Research, CUHK

Publication date: 2000-10-01

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