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World Neurosurg. 2016 Mar;87:61-4. doi: 10.1016/j.wneu.2015.11.097. Epub 2015 Dec 24.

Locoregional Anesthesia for Carotid Endarterectomy: Identification of Patients with Intolerance to Cross-Clamping.

Author information

1
Department of Neurosurgery, Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil; Department of Neurosurgery, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Neurosurgery, Hospital Mater Dei, Belo Horizonte, Minas Gerais, Brazil. Electronic address: mdellaretti@mac.com.
2
Department of Neurosurgery, Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil.
3
Department of Neurosurgery, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
4
Department of Neurosurgery, Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil; Department of Neurosurgery, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

Abstract

OBJECTIVE:

During carotid endarterectomy (CEA), carotid cross-clamping is performed to allow for artery incision and plaque removal. A small subgroup of patients can tolerate carotid occlusion for only a few seconds, if at all, without presenting neurologic deficit. These patients are described as having ''cross-clamp intolerance.'' The purpose of this study was to demonstrate the safety of locoregional anesthesia in identifying patients with cross-clamp intolerance and factors associated with this condition.

METHODS:

From August 2008 to May 2010, 115 consecutive patients were submitted to CEA under locoregional anesthesia at the Santa Casa de Belo Horizonte; the procedure was performed by the main author. Patients who showed intolerance to internal carotid artery (ICA) occlusion for <30 seconds were considered to have cross-clamp intolerance.

RESULTS:

Among the 115 participating patients, 9.6% (11 patients) showed intolerance to ICA occlusion and developed deficits in <30 seconds (i.e., these patients presented cross-clamp intolerance). The factor that was associated with cross-clamp intolerance was the mean degree of contralateral carotid stenosis, which was 57.5% for those who presented intolerance and 27.8% for those who tolerated ICA occlusion.

CONCLUSION:

Locoregional anesthesia is a safe method for identifying patients with cross-clamp intolerance. Patients with cross-clamp intolerance present contralateral stenosis that is greater on average than patients who readily tolerate carotid artery occlusion.

KEYWORDS:

Carotid endarterectomy; Carotid stenosis; Intolerance to cross-clamping; Regional anesthesia

PMID:
26724635
DOI:
10.1016/j.wneu.2015.11.097
[Indexed for MEDLINE]

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