内シャントを用いずに施行したCEA連続400症例における周術期脳梗塞の検討:―術中モニタリングおよび術後のDWIの結果より―

概要

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The use of intraluminal shunting during carotid endarterectomy (CEA) remains controversial. From January 2001 to September 2010, 400 CEAs without shunting were performed under general anesthesia by 14 neurosurgeons (2 consultants, 12 trainees). We used electroencephalography (EEG) and somatosensory evoked potential (SEP) to monitor under selective burst suppression using barbiturate or propofol administration during cross-clamping. In 66 of the 400 CEAs (16.5%), intraoperative monitoring demonstrated abnormalities after cross-clamping. In 26 (6.5%) of the 400 CEAs, new areas of diffusion hyperintensity were identified postoperatively. Within 30 days, the combined mortality and morbidity (symptomatic ischemia) rate was 2.8%. Thirteen (3.3%) patients presented with TIA. CEA without shunting can be safely performed with EEG and SEP monitoring under induced hypertention and selective burst suppression.
一般社団法人日本脳卒中の外科学会の論文