Is Near-Infrared Spectroscopy a Reliable Method to Evaluate Clamping Ischemia during Carotid Surgery?
Guidelines do not include cerebral oximetry among monitoring for carotid endarterectomy (CEA). The purpose of this study was to evaluate the reliability of near-infrared spectroscopy (NIRS) in the detection of clamping ischemia and in the prevention of clamping-related neurologic deficits using, as...
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| Format: | Article |
| Language: | English |
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Wiley
2012-01-01
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| Series: | Stroke Research and Treatment |
| Online Access: | http://dx.doi.org/10.1155/2012/156975 |
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| author | Luciano Pedrini Filippo Magnoni Luigi Sensi Emilio Pisano Maria Sandra Ballestrazzi Maria Rosaria Cirelli Alessandro Pilato |
| author_facet | Luciano Pedrini Filippo Magnoni Luigi Sensi Emilio Pisano Maria Sandra Ballestrazzi Maria Rosaria Cirelli Alessandro Pilato |
| author_sort | Luciano Pedrini |
| collection | DOAJ |
| description | Guidelines do not include cerebral oximetry among monitoring for carotid endarterectomy (CEA). The purpose of this study was to evaluate the reliability of near-infrared spectroscopy (NIRS) in the detection of clamping ischemia and in the prevention of clamping-related neurologic deficits using, as a cutoff for shunting, a 20% regional cerebral oxygen saturation (rSO2) decrease if persistent more than 4 minutes, otherwise a 25% rSO2 decrease. Bilateral rSO2 was monitored continuously in patients undergoing CEA under general anesthesia (GA). Data was recorded after clamping, declamping, during shunting and lowest values achieved. Preoperative neurologic, CT-scan, and vascular lesions were recorded.
We reviewed 473 cases: 305 males (64.5%) mean age 73.3±7.3. Three patients presented transient ischemic deficits at awakening, no perioperative stroke or death; 41 (8.7%) required shunting: 30 based on the initial rSO2 value and 11 due to a decrease during surgery. Using the ROC curve analysis we found, for a >25% reduction from baseline value, a sensitivity of 100% and a specificity of 90.6%. Reliability, PPV, and NPV were 95.38%, 9%, and 100%, respectively. In conclusion, this study indicates the potential reliability of NIRS monitoring during CEA under GA, using a cutoff of 25% or a cutoff of 20% for prolonged hypoperfusion. |
| format | Article |
| id | doaj-art-14d78705d6524b5fb8805629e0a72a3c |
| institution | Kabale University |
| issn | 2090-8105 2042-0056 |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke Research and Treatment |
| spelling | doaj-art-14d78705d6524b5fb8805629e0a72a3c2025-02-03T05:47:55ZengWileyStroke Research and Treatment2090-81052042-00562012-01-01201210.1155/2012/156975156975Is Near-Infrared Spectroscopy a Reliable Method to Evaluate Clamping Ischemia during Carotid Surgery?Luciano Pedrini0Filippo Magnoni1Luigi Sensi2Emilio Pisano3Maria Sandra Ballestrazzi4Maria Rosaria Cirelli5Alessandro Pilato6Operative Unit of Vascular Surgery, Department of Surgery, Maggiore Hospital of Bologna, 40133 Bologna, ItalyOperative Unit of Vascular Surgery, Department of Surgery, Maggiore Hospital of Bologna, 40133 Bologna, ItalyOperative Unit of Vascular Surgery, Department of Surgery, Maggiore Hospital of Bologna, 40133 Bologna, ItalyOperative Unit of Vascular Surgery, Department of Surgery, Maggiore Hospital of Bologna, 40133 Bologna, ItalyOperative Unit of Vascular Surgery, Department of Surgery, Maggiore Hospital of Bologna, 40133 Bologna, ItalyOperative Unit of Vascular Surgery, Department of Surgery, Maggiore Hospital of Bologna, 40133 Bologna, ItalyOperative Unit of Vascular Surgery, Department of Surgery, Maggiore Hospital of Bologna, 40133 Bologna, ItalyGuidelines do not include cerebral oximetry among monitoring for carotid endarterectomy (CEA). The purpose of this study was to evaluate the reliability of near-infrared spectroscopy (NIRS) in the detection of clamping ischemia and in the prevention of clamping-related neurologic deficits using, as a cutoff for shunting, a 20% regional cerebral oxygen saturation (rSO2) decrease if persistent more than 4 minutes, otherwise a 25% rSO2 decrease. Bilateral rSO2 was monitored continuously in patients undergoing CEA under general anesthesia (GA). Data was recorded after clamping, declamping, during shunting and lowest values achieved. Preoperative neurologic, CT-scan, and vascular lesions were recorded. We reviewed 473 cases: 305 males (64.5%) mean age 73.3±7.3. Three patients presented transient ischemic deficits at awakening, no perioperative stroke or death; 41 (8.7%) required shunting: 30 based on the initial rSO2 value and 11 due to a decrease during surgery. Using the ROC curve analysis we found, for a >25% reduction from baseline value, a sensitivity of 100% and a specificity of 90.6%. Reliability, PPV, and NPV were 95.38%, 9%, and 100%, respectively. In conclusion, this study indicates the potential reliability of NIRS monitoring during CEA under GA, using a cutoff of 25% or a cutoff of 20% for prolonged hypoperfusion.http://dx.doi.org/10.1155/2012/156975 |
| spellingShingle | Luciano Pedrini Filippo Magnoni Luigi Sensi Emilio Pisano Maria Sandra Ballestrazzi Maria Rosaria Cirelli Alessandro Pilato Is Near-Infrared Spectroscopy a Reliable Method to Evaluate Clamping Ischemia during Carotid Surgery? Stroke Research and Treatment |
| title | Is Near-Infrared Spectroscopy a Reliable Method to Evaluate Clamping Ischemia during Carotid Surgery? |
| title_full | Is Near-Infrared Spectroscopy a Reliable Method to Evaluate Clamping Ischemia during Carotid Surgery? |
| title_fullStr | Is Near-Infrared Spectroscopy a Reliable Method to Evaluate Clamping Ischemia during Carotid Surgery? |
| title_full_unstemmed | Is Near-Infrared Spectroscopy a Reliable Method to Evaluate Clamping Ischemia during Carotid Surgery? |
| title_short | Is Near-Infrared Spectroscopy a Reliable Method to Evaluate Clamping Ischemia during Carotid Surgery? |
| title_sort | is near infrared spectroscopy a reliable method to evaluate clamping ischemia during carotid surgery |
| url | http://dx.doi.org/10.1155/2012/156975 |
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