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  • Title: Local haemodynamic changes during carotid endarterectomy--the influence on cerebral oxygenation.
    Author: Kragsterman B, Pärsson H, Bergqvist D.
    Journal: Eur J Vasc Endovasc Surg; 2004 Apr; 27(4):398-402. PubMed ID: 15015190.
    Abstract:
    OBJECTIVES: To characterize carotid bifurcation haemodynamics and cerebral oxygenation during clamping and at reperfusion after carotid endarterectomy (CEA). MATERIALS AND METHODS: Sixty-two patients with a symptomatic high-grade stenosis of the internal carotid artery (ICA), who underwent CEA under general anaesthesia, were studied prospectively. Measurements of stump-pressure, volume flow (transit time flowmetry) and changes in cerebral oxygenation (near-infrared spectroscopy (NIRS)) were performed. Selective shunting was based on stump pressure only. RESULTS: Stump pressure correlated with both ICA flow before clamping (r=0.45; p=0.03) and changes in cerebral oxygenation (rSO2) during clamping (r=0.61; p=0.002), the latter was reversed by shunt placement. ICA flow before clamping also correlated with changes in rSO2 during clamping (r=0.41; p=0.01). CONCLUSION: Measurements with transit time flowmetry and cerebral oximetry are technically easy and help to determine the need for selective shunting during CEA. High ICA flow before clamping in combination with a low stump pressure usually indicates the need for a shunt. Volume flow measurements may also be useful in the quality assessment of the CEA.
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