Abstract
There are serious cerebral ischemic problems in carotid endarterectomy (CEA) due to ICA cross clamping and embolism. We performed 110 CEA's using an internal shunt system. Preoperatively Matas test was evaluated with rCBF and intraoperatively ICA stump pressure and SEP were monitored. Meticurous postoperative neurological examinations revealed 10 cases showing transient deterioration of preoperatively observed symptoms and 2 other cases presenting new serious deficits. The former would be due to cerebral ischemia by ICA cross clamping, but the later might be due to embolism; the symptoms were observed at 6 months after surgery. In most of these 12 cases, rCBF in Matas test were below 30ml/100g/min. ICA stump pressure varied from 22 to 90mmHg and evident change in SEP was observed in 6 cases. Cross clamping time over 30 minutes was seen in 3 cases. Patients presenting low rCBF in Matas test with stump pressure below 35mmHg and/or prominent SEP change during ICA cross clamping are susceptible to brain damage. Therefore, intraoperative brain protection by application of shunt system, heparinization, shortening of ICA cross clamp and blood pressure control must be prerequisite for establishing a safety procedure of CEA.
