Abstract

Objective

Patients undergoing carotid endarterectomy (CEA) may experiment neurologic deficits during the carotid cross-clamping due to secondary cerebral hypoperfusion. An associated risk of postoperative stroke incidence is also well established. This work aimed to assess the postoperative adverse events related to neurologic deficits in the awake test after clamping and to determine its predictive factors. Methods. From January 2012 to January 2018, 79 patients from a referral hospital that underwent CEA with regional anesthesia for carotid stenosis and manifested neurologic deficits were gathered. Consecutively selected controls (n = 85) were submitted to the same procedure without developing neurological changes. Postoperative complications such as stroke, myocardial infarction, all-cause death, and Clavien–Dindo classification were assessed 30 days after the procedure. Univariate and binary logistic regressions were performed for data assessment. Results. Patients with clamping associated neurologic deficits were significantly more obese than the control group (aOR = 9.30; 95% CI: 2.57–33.69; p = .01). Lower degree of ipsilateral stenosis and higher degree of contralateral stenosis were independently related to clamping intolerance (aOR = 0.70; 95% CI: 0.49–0.99; p = .047 and aOR = 1.30; 95% CI: 1.06–1.50; p = .009, respectively). Neurologic deficits were a main 30-day stroke predictor (aOR = 4.30; 95% CI: 1.10–16.71; p = .035). Conclusions. Neurologic deficits during carotid clamping are a predictor of perioperative stroke. Body mass index > 30 kg/m², a lower degree of ipsilateral stenosis, and a higher degree of contralateral stenosis are independent predictors of neurologic deficits and, therefore, might play a role in the prevention of procedure-related stroke.

中文翻译：

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区域麻醉下颈动脉内膜切除术术中神经功能缺损的影响

摘要

客观的

由于继发性脑灌注不足，接受颈动脉内膜切除术 (CEA) 的患者可能会在颈动脉交叉钳夹期间出现神经功能缺损。术后卒中发生的相关风险也已明确。这项工作旨在评估与钳夹后清醒试验中神经功能缺损相关的术后不良事件，并确定其预测因素。方法。2012年1月至2018年1月，79例因颈动脉狭窄并有神经功能缺损而行CEA局部麻醉的转诊医院患者。连续选择的控件 ( n = 85) 接受相同的程序而没有发生神经系统变化。在手术后 30 天评估术后并发症，例如中风、心肌梗塞、全因死亡和 Clavien-Dindo 分类。进行单变量和二元逻辑回归以进行数据评估。结果。有钳夹相关神经功能缺损的患者明显比对照组更肥胖（aOR = 9.30；95% CI：2.57–33.69；p  = .01）。较低程度的同侧狭窄和较高程度的对侧狭窄与钳夹不耐受独立相关（aOR = 0.70；95% CI：0.49–0.99；p  = .047 和 aOR = 1.30；95% CI：1.06–1.50；p = .009，分别）。神经功能缺损是 30 天卒中的主要预测因素（aOR = 4.30；95% CI：1.10–16.71；p  = .035）。结论。颈动脉钳夹期间的神经功能缺损是围手术期卒中的预测因素。体重指数 > 30 kg/m ²、较低程度的同侧狭窄和较高程度的对侧狭窄是神经功能缺损的独立预测因子，因此可能在预防与手术相关的中风中发挥作用。