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BEYAZ MO, URFALI S, KAYA S, ORUÇ D, ÇÖMEZ M, HAKİMOĞLU S, KOYUNCU O, MELEK I, FANSA İ. Servikal blok altında karotis endarterektomi operasyonu sonuçlarımız: Anadolu’da bir merkezde ilk uygulama. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.1061031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Pereira-Neves A, Saramago S, Duarte-Gamas L, Domingues-Monteiro D, Fragão-Marques M, Marques-Vieira M, Andrade JP, Pais S, Rocha-Neves J. MEAN PLATELET VOLUME PREDICTS RESTENOSIS AFTER CAROTID ENDARTERECTOMY. Ann Vasc Surg 2021; 81:216-224. [PMID: 34748948 DOI: 10.1016/j.avsg.2021.08.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/17/2021] [Accepted: 08/31/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Carotid restenosis following carotid endarterectomy (CEA) has a cumulative risk at 5-years up to 32%, which may impact the well-being of patients following CEA. Haematological parameters in the standard complete blood cell count (CBC) are emerging as potential biomarkers, but their application in CEA is scarce. The primary aim of this study was to investigate haematological markers for restenosis following CEA. The secondary aim was to characterize clinical risk factors for restenosis. METHODS From January 2012 to January 2019, 151 patients who underwent CEA under regional anaesthesia due to carotid stenosis were selected from a prospectively maintained cohort database. Patients were included if a preoperative CBC was available in the two weeks preceding CEA. Multivariable analysis was performed alongside propensity score matching (PSM) analysis, using the preoperative CEA parameters, to reduce confounding factors between categories. RESULTS The study group comprised 28 patients who developed carotid restenosis. The remaining 123 patients without restenosis composed the control group. Mean age of the patients did not differ significantly between groups (70.25±8.05 vs. 70.32 ± 9.61 YO, p=0.973), neither did gender (male gender 89.3% vs. 78.9%, p=0.206). Regarding haematological parameters, only MPV remained statistically significant within multivariable analysis (1.855, aOR [1.174-2.931], p=0.008), a result supported by PSM analysis (2.072, aOR [1.036-4.147], p=0.042). CONCLUSION MPV was able to predict restenosis two years after CEA. Thus, MPV can be incorporated into score calculations to identify patients at greater risk of restenosis, who could benefit from specific monitoring during follow-up. While results are promising, more research is necessary to corroborate them.
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Affiliation(s)
- António Pereira-Neves
- Department of Biomedicine - Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - Sean Saramago
- Faculdade de Medicina e Ciências Biomédicas, Universidade do Algarve, Campus de Gambelas Ed. 2 - Piso 1, Gab. 1.6, 8005-139 Faro, Portugal.
| | - Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - Diogo Domingues-Monteiro
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - Mariana Fragão-Marques
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal; Cardiovascular R&D Unit, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - Mário Marques-Vieira
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Hospital de Braga, EPE, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - José P Andrade
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
| | - Sandra Pais
- Faculdade de Medicina e Ciências Biomédicas, Universidade do Algarve, Campus de Gambelas Ed. 2 - Piso 1, Gab. 1.6, 8005-139 Faro, Portugal; Comprehensive Health Research Centre (CHRC), Lisboa, Campus de Gambelas Ed. 2 - Piso 1, Gab. 1.6, 8005-139 Faro, Portugal; Centro Internacional sobre o Envelhecimento, Campus de Gambelas Ed. 2 - Piso 1, Gab. 1.6, 8005-139 Faro, Portugal; ABC-RI, Algarve Biomedical Center Research Institute, Campus de Gambelas Ed. 2 - Piso 1, Gab. 1.6, 8005-139 Faro, Portugal.
| | - João Rocha-Neves
- Department of Biomedicine - Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200 - 319 Porto, Portugal.
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Pereira-Neves A, Rocha-Neves J, Fragão-Marques M, Duarte-Gamas L, Jácome F, Coelho A, Cerqueira A, Andrade JP, Mansilha A. Red blood cell distribution width is associated with hypoperfusion in carotid endarterectomy under regional anesthesia. Surgery 2021; 169:1536-1543. [PMID: 33610341 DOI: 10.1016/j.surg.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND A subset of patients submitted to carotid endarterectomy under regional anesthesia develop intraoperative neurologic deficit during carotid artery crossclamping related to critical cerebral perfusion, which may be owing to low flow or embolic phenomena. This subgroup is deemed prone to worse outcomes, which highlights its clinical relevance. The main aim of this study was to identify clinical and hematological predictors for intraoperative neurologic deficit. The secondary aim was to evaluate the perioperative prognostic value of postcarotid artery crossclamping manifestations of cerebral ischemia. METHODS Between January 2012 to January 2020, patients submitted to carotid endarterectomy under regional anesthesia in a tertiary referral center who presented intraoperative neurologic deficit were prospectively and consecutively included. This group constituted 8% of the total carotid endarterectomy performed in the center during this timeframe. The control group of patients was the subsequent patient submitted to carotid endarterectomy without intraoperative neurologic deficit in a 1:1 ratio. Blood samples were collected before surgery (<2 weeks). Propensity score matching was used to identify well-matched pairs of patients. RESULTS A total of 180 patients were included, with 90 (50% of the cohort and 8% of total carotid endarterectomies) presenting intraoperative neurologic deficit associated to clamping. Mean age was 71.4 ± 9.27 years in the study group and 68.8 ± 8.36 years in the control group. The clinical variables presenting significance after multivariate analysis include: age (adjusted odds ratio: 1.04, 5-95% confidence interval, [1.003-1.078]; P = .034), obesity (adjusted odds ratio: 3.537 [1.445-8.658]; P = .006), lower ipsilateral carotid stenosis grade (adjusted odds ratio: 0.725 [0.525-0.997]; P = .049), and higher contralateral carotid stenosis grade (adjusted odds ratio: 1.266 [1.057-1.516]; P = .010). Red cell distribution width coefficient of variation demonstrated statistical significance in predicting intraoperative neurologic deficit with an adjusted odds ratio of 1.394 (1.076-1.805); P = .012. The 30-day stroke rate was significantly higher in the intraoperative neurologic deficit group, with an adjusted odds ratio of 5.13 (5-95% confidence interval [1.058-24.87]; P = .042) after propensity score matching. Postoperative complications (Clavien-Dindo ≥2) were also associated with intraoperative neurologic deficit (after propensity score matching adjusted odds ratio of 2.748 [5-95% confidence interval, 0.976-7.741]; P = .051). CONCLUSION In this study, increased red cell distribution width coefficient of variation demonstrated value to predict intraoperative neurologic deficit. Additionally, age, obesity, a lower degree of ipsilateral carotid stenosis, and a higher degree of contralateral carotid stenosis also demonstrated ability to predict intraoperative neurologic deficit. Moreover, intraoperative neurologic deficit was an independent risk factor for 30-day stroke and postoperative complications Clavien-Dindo ≥2.
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Affiliation(s)
- António Pereira-Neves
- Department of Biomedicine-Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal.
| | - João Rocha-Neves
- Department of Biomedicine-Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Mariana Fragão-Marques
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Clinical Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal; Cardiovascular R & D Unit, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Luís Duarte-Gamas
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Filipa Jácome
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
| | - Andreia Coelho
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal
| | - Alfredo Cerqueira
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José P Andrade
- Department of Biomedicine-Unit of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Armando Mansilha
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
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Rocha-Neves JP, Pereira-Macedo J, Moreira AL, Oliveira-Pinto JP, Afonso G, Mourão J, Andrade JP, Vaz RP, Mansilha A. Efficacy of near-infrared spectroscopy cerebral oximetry on detection of critical cerebral perfusion during carotid endarterectomy under regional anesthesia. VASA 2020; 49:367-374. [DOI: 10.1024/0301-1526/a000879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Summary: Background: Patients undergoing carotid endarterectomy (CEA) may suffer from cerebral hypoperfusion during the carotid cross-clamping. Near-infrared spectroscopy cerebral oximetry (NIRS) is a non-invasive method of regional cerebral oxygen saturation measurement reflecting changes in cerebral blood flow during CEA. The main goal of the study was to evaluate the accuracy of the NIRS in detecting cerebral hypoperfusion during CEA under regional anesthesia (RA) and compare it with awake neurological testing. Patients and methods: A prospective observational study of 28 patients that underwent CEA in RA and manifested neurologic deficits, and 28 consecutive controls from a tertiary and referral center, was performed. All patients were monitored with NIRS cerebral oximetry and awake testing as the control technique. Subsequently, operating characteristic curve and Cohen’s kappa coefficient were determined to evaluate the reliability of the monitoring test. Results: NIRS presented a sensitivity of 27.3% and a specificity of 89.3% in comparison to awake testing. Receiver operating characteristic (ROC) curve analysis demonstrated that a decrease of at least 20% in cerebral oxygen saturation is the best threshold to infer cerebral hypoperfusion. However, the respective area under the curve (AUROC) was 0.606 (95% CI: 0.456–0.756, P = 0.178) with a calculated Cohen’s kappa of 0.179, P = 0.093. Regarding 30-days outcomes, only awake testing has shown significant associations with stroke and postoperative complications ( P = 0.043 and P = 0.05), which were higher in patients with post-clamping neurologic deficits. Conclusions: NIRS demonstrated a reduced discriminative capacity for critical cerebral hypoperfusion, and does not seem to add substantial clinical benefits to the awake test.
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Affiliation(s)
- João P. Rocha-Neves
- Department of Biomedicine, Unity of Anatomy, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | | | - André L. Moreira
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Department of Anesthesiology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Cardiovascular R&D Unit, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - José P. Oliveira-Pinto
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Cardiovascular R&D Unit, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Graça Afonso
- Departamento de Anestesiologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Joana Mourão
- Departamento de Anestesiologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Serviço de Anestesiologia, Centro Hospitalar São João, Porto, Portugal
| | - José P. Andrade
- Department of Biomedicine, Unity of Anatomy, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Ricardo P. Vaz
- Department of Biomedicine, Unity of Anatomy, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Armando Mansilha
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Rocha-Neves JM, Pereira-Macedo J, Dias-Neto MF, Andrade JP, Mansilha AA. Benefit of selective shunt use during carotid endarterectomy under regional anesthesia. Vascular 2020; 28:505-512. [DOI: 10.1177/1708538120922098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Carotid cross-clamping during endarterectomy exposes the patient to intraoperative neurological deficits due to embolism or cerebral hypoperfusion. To prevent further cerebrovascular incidents, resorting to shunt is frequently recommended. However, since this method is also considered a stroke risk factor, the use is still controversial. This study aims to shed some light on the best approach regarding the use of shunt in symptomatic cerebral malperfusion after carotid artery cross-clamping. Methods From January 2012 to January 2018, 79 patients from a tertiary referral hospital who underwent carotid endarterectomy with regional anesthesia for carotid artery stenosis and manifested post-clamping neurologic deficits were prospectively gathered. Shunt use was left to the decision of the surgeon and performed in 31.6% (25) of the patients. Demographics, comorbidities, imaging tests, and clinical/intraoperative features were evaluated. For data assessment, univariate analysis was performed. Results Regarding 30-day stroke, 30-day postoperative complications (stroke, surgical hematoma, hyperperfusion syndrome), and cranial nerve injury, no significant differences were found ( P = 0.301, P = 0.460, and P = 0.301, respectively) between resource to shunt and non-shunt. Clamping and surgery times were significantly higher in the shunt group ( P < 0.001 and P = 0.0001, respectively). Conclusions Selective-shunting did not demonstrate superiority for patients who developed focal deficits regarding stroke or other postoperative complications. However, due to the limitations of this study, the benefit of shunting cannot be excluded. Further randomized trials are recommended for precise results on this matter with current sparse clinical evidence.
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Affiliation(s)
- João M Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Biomedicine – Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Department of Physiology and Surgery, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Juliana Pereira-Macedo
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Marina F Dias-Neto
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Physiology and Surgery, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - José Paulo Andrade
- Department of Biomedicine – Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Armando A Mansilha
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Physiology and Surgery, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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