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Preoperative evaluation of patients with extracranial carotid disease. Plethysmographic criteria for the use of a shunt, and for avoidance of surgery

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Summary

Eighty five angiographically studied patiens (mean age 52) with carotid artery disease were preoperatively evaluated for the type and adequacy of their collateral circulation by the use of supraorbital photo-electric plethysmography (SPP). According to certain criteria we identified the candidates for surgery with or without shunt or for conservative treatment.

Sixty patients presented evidence of extrancranial collateral mainly from the ipsilateral superficial temporal artery (49 of 60), 11 patients revealed evidence of intracranial collateral mainly from the contralateral internal carotid artery (9 of 11), while in the rest, 14 patients, the source of the collateral circulation was undeterminable. Furthermore, an adequate circle of Willis was found in 67 patients and an inadequate one in the rest 7 (4 of 60, and 3 of 14). The majority of the surgically treated patients (74 of 81) were subjected to surgery without shunt (91%) while only 7 necessitated the use of a shunt (9%). No neurological complication was encountered and the single death (1.3%) was not directly related to the surgery itself.

According to the present study, the careful preoperative determination of the collateral circulation, with the simple technique of SPP and the identification of patients at high risk under certain criteria could help the surgeon to decide about the advisability of a shunt or not and about the avoidance of surgery as well. This technique may be valuable where other more sophisticated forms of monitoring, such as EEG, evoked potentials or blood flow, are not readily available.

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References

  1. Baker WH, Dorner DB, Barnes RW (1977) Carotid endarterectomy. Is an indwelling shunt necessary? Surgery 82: 321–326

    PubMed  Google Scholar 

  2. Bland JE, Chapman RQ, Wylie EJ (1970) Neurological complication of carotid artery surgery. Ann Surg 171: 459–464

    PubMed  Google Scholar 

  3. Cooley DA, Al Naaman YD, Carton CA (1956) Surgical treatment of arteriosclerotic occlusion of common carotid artery. J Neurosurg 13: 500–506

    PubMed  Google Scholar 

  4. Ferguson GG (1986) Carotid endarterectomy. To shunt or not to shunt? Arch Neurol 43: 615–616

    PubMed  Google Scholar 

  5. Ferguson GG, Blume WT, Farrar JK (1985) Carotid endarterectomy. An evaluation of results in 282 consecutive cases in relationship to intraoperative monitoring. Abstract No 54, Program of the Annual Meeting of the American Association of Neurological Surgeons, Atlanta, April 23, 1985

  6. Ferguson GG, Gamache FW (1984) Cerebral protection during carotid endarterectomy. Intraoperative monitoring, anesthetic techniques and temporary shunts. In: Smith RR (ed) Stroke and the extracranial vessels. Raven Press, New York, pp 187–201

    Google Scholar 

  7. Fisher CM (1954) Occlusion of the carotid arteries: further experiences. Arch Neurol Psych 72: 187–204

    Google Scholar 

  8. Gado M, Marshall J (1971) Clinico-radiological study of collateral circulation after internal carotid and middle cerebral occlusion. J Neurol Neurosurg Psychiatry 34: 163–170

    PubMed  Google Scholar 

  9. Goss MC (1981) Gray's anatomy. Lee and Febinger, Philadelphia, pp 577–601

    Google Scholar 

  10. Hachinski V. (1986) Shunting during carotid endarterectomy. Arch Neurol 43: 618

    Google Scholar 

  11. Jacobs LA, Brinkman SD, Morrell RM, Shirley JG, Ganji S (1983) Long-latency somatosensory evoked potentials during carotid endarterectomy. The American Surgeon 49: 338–344

    PubMed  Google Scholar 

  12. Liebermann A (1977) Directional Doppler in occlusive cerebrovascular disease. Stroke 8: 629

    PubMed  Google Scholar 

  13. Markand OM, Dilley RS, Moorthy SS, Warren C (1984) Monitoring of somatosensory evoked responses during carotid endarterectomy. Arch Neurol 41: 375–378

    PubMed  Google Scholar 

  14. Moorthy SS, Markand OH, Dilley RS, McCammon RL, Warren CH (1982) Somatosensory evoked responses during carotid endarterectomy. Anesth Analg 61: 879–883

    PubMed  Google Scholar 

  15. Müller HR (1972) The diagnosis of internal carotid artery occlusion by directional Doppler sonography of the ophthalmic artery. Neurology 22: 816–823

    PubMed  Google Scholar 

  16. NINCDS Ad Hoc Committee in Cerebrovascular Disease (1975) A classification and outline of cerebrovascular diseases. Stroke 6: 565–616

    Google Scholar 

  17. Nishioka H (1966) Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section 8, part I. Results of the treatment of intracranial aneurysms by occlusion of the carotid artery in the neck. J Neurosurg 25: 660–682

    PubMed  Google Scholar 

  18. Nornes H (1973) The role of the circle of Willis in graded occlusion of the internal carotid artery in man. Acta Neurochir (Wien) 28: 165–177

    Google Scholar 

  19. Ojemann RG, Heros RC (1986) Carotid endarterectomy. To shunt or not to shunt? Arch Neurol 43: 617–618

    PubMed  Google Scholar 

  20. Patterson HR (1974) Risk of carotid surgery with occlusion of the contralateral carotid artery. Arch Neurol 30: 188–189

    PubMed  Google Scholar 

  21. Pitts F (1962) Variations of collateral circulation in internal carotid occlusion. Comparison of clinical and x-ray findings. Neurology 12: 467–471

    PubMed  Google Scholar 

  22. Rainer WG, Guillen L, Blommquist CDet al (1968) Carotid artery: morbidity and mortality in 257 operations. Am J Surg 116: 678–681

    Google Scholar 

  23. Russ W, Fraedrich G (1984) Intraoperative detection of cerebral ischemia with somatosensory cortical evoked potentials during carotid endarterectomy. Presentation of a new method. Thorac Cardiovasc Surg 32: 124–126

    PubMed  Google Scholar 

  24. Tada K, Nukada T, Yoneda S, Kuriyama Y, Abe H (1975) Assessment of the capacity of cerebral circulation using ultrasonic Doppler technique. J Neurol Neurosurg Psychiatry 38: 1068–1075

    PubMed  Google Scholar 

  25. Toole JF (1966) Intraarterial shunts in the cerebral circulation. Circulation 33: 474–483

    PubMed  Google Scholar 

  26. Weaver GR, Howard G, McKinney MW, Ball RM, Jones MA, Toole FJ (1980) Comparison of Doppler Ultrasonography and arteriography of carotid artery bifurcation. Stroke 11 (4): 202–204

    Google Scholar 

  27. Whitney DG, Kahn EM, Estes JW, Jones CE (1980) Carotid artery surgery without a temporary indwelling shunt, in one thousand nine hundred seventeen consecutive procedures. Arch Surg 115: 1393–1399

    PubMed  Google Scholar 

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Authors and Affiliations

  1. B-Department of Neurology, Agios Demetrios Hospital, Greece

    N. Artemis, D. Kiskinis, D. Karacostas, G. Karoutas, Th. Halkias, Ch. Liasidis & J. Milonas

  2. A-Surgery Department, AHEPA Hospital, Thessaloniki, Greece

    N. Artemis, D. Kiskinis, D. Karacostas, G. Karoutas, Th. Halkias, Ch. Liasidis & J. Milonas

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  1. N. Artemis
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  2. D. Kiskinis
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Artemis, N., Kiskinis, D., Karacostas, D. et al. Preoperative evaluation of patients with extracranial carotid disease. Plethysmographic criteria for the use of a shunt, and for avoidance of surgery. Acta neurochir 91, 100–105 (1988). https://doi.org/10.1007/BF01424562

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