Short-term outcomes after selective shunt during carotid endarterectomy : a propensity score matching analysis
Copyright © 2023 Sociedad Española de Neurocirugía. Published by Elsevier España, S.L.U. All rights reserved..
INTRODUCTION AND OBJECTIVES: Carotid cross-clamping during carotid endarterectomy might lead to intraoperative neurologic deficits, increasing stroke/death risk. If deficits are detected, carotid shunting has been recommended to reduce the risk of stroke. However, shunting may sustain a specific chance of embolic events and subsequently incurring harm. Current evidence is still questionable regarding its clear benefit. The aim is to determine whether a policy of selective shunt impacts the complication rate following an endarterectomy.
MATERIAL AND METHODS: From January 2013 to May 2021, all patients undergoing carotid endarterectomy under regional anesthesia with intraoperative neurologic alteration were retrieved. Patients submitted to selective shunt were compared to a non-shunt group. A 1:1 propensity score matching (PSM) was performed. Differences between the groups and clinical outcomes were calculated, resorting to univariate analysis.
RESULTS: Ninety-eight patients were selected, from which 23 were operated on using a shunt. After PSM, 22 non-shunt patients were compared to 22 matched shunted patients. Concerning demographics and comorbidities, both groups were comparable to pre and post-PSM, except for chronic heart failure, which was more prevalent in shunted patients (26.1%, P=0.036) in pre-PSM analysis. Regarding 30-day stroke and score Clavien-Dindo ≥2, no significant association was found (P=0.730, P=0.635 and P=0.942, P=0.472, correspondingly, for pre and post-PSM).
CONCLUSIONS: In this cohort, resorting to shunting did not demonstrate an advantage regarding 30-day stroke or a Clavien-Dindo ≥ 2 rates. Nevertheless, additional more extensive studies are mandatory to achieve precise results concerning the accurate utility of carotid shunting in this subset of patients under regional anesthesia.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:35 |
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| Enthalten in: |
Neurocirugia (English Edition) - 35(2024), 2 vom: 31. März, Seite 71-78 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Pereira-Macedo, Juliana [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 11.03.2024 Date Revised 11.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.neucie.2023.07.006 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM361938446 |
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| 100 | 1 | |a Pereira-Macedo, Juliana |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Short-term outcomes after selective shunt during carotid endarterectomy |b a propensity score matching analysis |
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| 500 | |a Date Revised 11.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Sociedad Española de Neurocirugía. Published by Elsevier España, S.L.U. All rights reserved. | ||
| 520 | |a INTRODUCTION AND OBJECTIVES: Carotid cross-clamping during carotid endarterectomy might lead to intraoperative neurologic deficits, increasing stroke/death risk. If deficits are detected, carotid shunting has been recommended to reduce the risk of stroke. However, shunting may sustain a specific chance of embolic events and subsequently incurring harm. Current evidence is still questionable regarding its clear benefit. The aim is to determine whether a policy of selective shunt impacts the complication rate following an endarterectomy | ||
| 520 | |a MATERIAL AND METHODS: From January 2013 to May 2021, all patients undergoing carotid endarterectomy under regional anesthesia with intraoperative neurologic alteration were retrieved. Patients submitted to selective shunt were compared to a non-shunt group. A 1:1 propensity score matching (PSM) was performed. Differences between the groups and clinical outcomes were calculated, resorting to univariate analysis | ||
| 520 | |a RESULTS: Ninety-eight patients were selected, from which 23 were operated on using a shunt. After PSM, 22 non-shunt patients were compared to 22 matched shunted patients. Concerning demographics and comorbidities, both groups were comparable to pre and post-PSM, except for chronic heart failure, which was more prevalent in shunted patients (26.1%, P=0.036) in pre-PSM analysis. Regarding 30-day stroke and score Clavien-Dindo ≥2, no significant association was found (P=0.730, P=0.635 and P=0.942, P=0.472, correspondingly, for pre and post-PSM) | ||
| 520 | |a CONCLUSIONS: In this cohort, resorting to shunting did not demonstrate an advantage regarding 30-day stroke or a Clavien-Dindo ≥ 2 rates. Nevertheless, additional more extensive studies are mandatory to achieve precise results concerning the accurate utility of carotid shunting in this subset of patients under regional anesthesia | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Anestesia regional | |
| 650 | 4 | |a Carotid clamping | |
| 650 | 4 | |a Carotid shunting | |
| 650 | 4 | |a Cerebral hypoperfusion | |
| 650 | 4 | |a Derivación carotídea | |
| 650 | 4 | |a Derivación selectiva | |
| 650 | 4 | |a Déficits neurológicos intraoperatorios | |
| 650 | 4 | |a Hipoperfusión cerebral | |
| 650 | 4 | |a Intraoperative neurologic deficits | |
| 650 | 4 | |a Pinzamiento carotídeo | |
| 650 | 4 | |a Regional anesthesia | |
| 650 | 4 | |a Selective shunt | |
| 700 | 1 | |a Duarte-Gamas, Luís |e verfasserin |4 aut | |
| 700 | 1 | |a Pereira-Neves, António |e verfasserin |4 aut | |
| 700 | 1 | |a de Andrade, José José Paulo |e verfasserin |4 aut | |
| 700 | 1 | |a Rocha-Neves, João |e verfasserin |4 aut | |
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| 773 | 1 | 8 | |g volume:35 |g year:2024 |g number:2 |g day:31 |g month:03 |g pages:71-78 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.neucie.2023.07.006 |3 Volltext |
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