Karotis Endarterektomi Operasyonu Sırasında Serebral Perfüzyonun Takibi ve Korunması: NIRS ve Kök Basıncı Rehberliğinde Seçici Şant Kullanımı

Year 2022, Volume: 9 Issue: 2, 115 - 120, 24.08.2022

Serkan Yazman , Burak Can Depboylu , Buğra Harmandar , Kadir Arslan , Mürüvvet Funda Tetik Saruhan , Ersin Yılmaz

https://doi.org/10.47572/muskutd.1045446

Abstract

Karotis arter cerrahisinde endarterektomi ve eversiyon metotları semptomatik veya asemptomatik hastalarda inme ve mortalite oranını azaltmaya yönelik uygulanan düşük riskli altın standart tedavi yöntemleridir. Serebral hipoperfuzyon ve iskeminin erken tespiti için yakın kızılötesi spektroskopi (NIRS) yöntemi ile rejyonel serebral oksijen saturasyonu (rSO2) ve karotis kök basıncı ölçümü yaygın kullanılan yöntemlerdir. Serebral hipoperfuzyonu engellemek ve serebral iskemi riskini azaltmak amaçlı en yaygın kullanılan yöntem intraoperatif şant kullanılmasıdır. Çalışmamızda karotis kök basıncı eşik değeri ≤40mmhg şant kullanımına karar verilen hastalarda, NIRS rSO2 değerindeki azalma, şant kullanımının peroperatif inme ve mortalite üzerine etkilerini araştırmayı amaçladık. 2018-2020 yılları arasında Kuzey Amerika semptomatik karotis endarterektomi çalışması (NASCET) kriterlerine göre %70-99 oranında darlık saptanan ve opere edilen 40 hasta retrospektif olarak değerlendirilmiştir. Şant kullanılan ve kullanılmayan grupta ipsilateral NIRS değerleri sırası ile ortalama klemp öncesi 70.33±8.40 ve 65.1±4.52, klemp konulduktan sonraki ilk dakikada 57.87±8.4 ve 62.01±4.6 saptandı (p<0.05). Çalışmamızda NIRS rSO2’deki ≥%15 düşme ile kök basıncı ≤40mmhg eşik değeri arasında iyi bir korelasyon olduğunu düşünmekteyiz. Bu değerler ile şant kullanım kararı verilen hastalarımızda peroperatif inme ve ölüm ile karşılaşılmamıştır. Ancak rSO2’deki düşmenin net bir sınır değerinin belirlenebilmesi için daha fazla prospektif ve çok merkezli çalışmalara ihtiyaç vardır. 

Keywords

Karotis, Kök Basıncı, NIRS, Şant

Monitoring and Maintaining Cerebral Perfusion During Carotid Endarterectomy: Use of Selective Shunt Under NIRS and Root Pressure Guidance

Abstract

Endarterectomy and eversion methods in carotid artery surgery are low-risk gold standard treatment methods applied to reduce the rate of stroke and mortality in symptomatic or asymptomatic patients. Regional cerebral oxygen saturation (rSO2) by near infrared spectroscopy (NIRS) method and carotid root pressure measurement are commonly used methods for early detection of cerebral hypoperfusion and ischemia. The most commonly used method to prevent cerebral hypoperfusion and reduce the risk of cerebral ischemia is the use of intraoperative shunts. In our study, we aimed to investigate the effects of decrease in NIRS rSO2 value and the effects of shunt use on peroperative stroke/mortality in patients who were decided to use shunt with a carotid root pressure value of ≤40mmHg. Between 2018 and 2020, 40 patients with stenosis of 70-99% according to North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria and operated on were evaluated retrospectively. The mean ipsilateral NIRS values were 70.33±8.40 and 65.1±4.52 before clamping, 57.87±8.4 and 62.01±4.6 at the first minute after clamping in the shunt and non-shunt groups, respectively (p<0.05). In our study there is a good correlation between ≥15% reduction in NIRS rSO2 and ≤40mmHg root pressure threshold. Peroperative stroke and death were not encountered in our patients for whom the decision to use shunt was made with these values. However, we need larger prospective multicentre studies to identify the optimal cut-off value for the decrease in rSO2. 

Keywords

Carotid, NIRS, Root Pressure, Shunt

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