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Peroperative neuromonitoring during carotid endarterectomy in relation to preoperative positron emission tomography findings.

Rijbroek A, Boellaard R, Vriens EM, Lammertsma AA, Rauwerda JA

Department of General Surgery, Kennemer Gasthuis, Haarlem, The Netherlands. rijbroek@kg.nl

OBJECTIVES: To compare stump pressure (SP), transcranial Doppler (TCD), electroencephalography (EEG) and selective shunting during carotid endarterectomy (CEA) with preoperative positron emission tomography (PET) parameters. MATERIALS AND METHODS: Preoperative PET measurements and peroperative neuromonitoring were performed in ten patients undergoing CEA for symptomatic carotid artery disease. PET parameters measured were cerebral blood flow (CBF), oxygen extraction fraction (OEF), cerebral oxygen metabolism (CMRO(2)), cerebral blood volume (CBV), mean vascular transit time (MVTT) and cerebral perfusion pressure (CPP). Results of these measurements in ipsilateral medial cerebral artery (MCA), ipsilateral hemisphere and total cerebrum were compared with absolute mean SP, mean SP<40mmHg, TCD, EEG changes and selective shunting. RESULTS: None of the PET parameters showed any significant correlations with peroperative neuromonitoring findings. There were only trends for correlations of CBF and MVTT with TCD changes and of CPP and CMRO(2) with selective shunting. CONCLUSIONS: Preoperative PET examinations are not useful for predicting the need for shunting during CEA.

Published 19 May 2008 in Eur J Vasc Endovasc Surg, 35(6): 652-60.
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