Abstract：
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.
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.
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).
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.
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.
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).
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.
摘要：
目的：颈动脉内膜切除术中颈动脉交叉钳夹可能导致术中神经功能缺损，增加中风/死亡风险。如果发现缺陷，颈动脉分流术已被推荐用于降低中风的风险。然而,分流可能会维持栓塞事件的特定机会并随后造成伤害。关于其明显的益处，目前的证据仍然值得怀疑。目的是确定选择性分流政策是否会影响动脉内膜切除术后的并发症发生率。
方法：从2013年1月至2021年5月，在区域麻醉下进行颈动脉内膜切除术的所有患者进行术中神经系统改变。将接受选择性分流的患者与非分流组进行比较。进行1:1倾向评分匹配(PSM)。计算组间差异和临床结果，诉诸单变量分析。
结果：选择98例患者，其中23人使用分流术进行手术。PSM之后,将22名非分流患者与22名匹配的分流患者进行比较。关于人口统计学和合并症，两组均与PSM前和后相当，除了慢性心力衰竭,在分流患者中更为普遍(26.1%，在PSM前分析中P=0.036)。关于30天的卒中和Clavien-Dindo评分≥2，没有发现显着关联（P=0.730，P=0.635和P=0.942，P=0.472，相应地，对于PSM之前和之后)。
结论：在这个队列中，对于30天的卒中或Clavien-Dindo≥2的发生率，采用分流术未显示出优势。然而，需要更多更广泛的研究来获得关于颈动脉分流在区域麻醉下的这一部分患者中的准确效用的准确结果.
方法：从2013年1月至2021年5月，在区域麻醉下进行颈动脉内膜切除术的所有患者进行术中神经系统改变。将接受选择性分流的患者与非分流组进行比较。进行1:1倾向评分匹配(PSM)。计算组间差异和临床结果，诉诸单变量分析。
结果：选择98例患者，其中23人使用分流术进行手术。PSM之后,将22名非分流患者与22名匹配的分流患者进行比较。关于人口统计学和合并症，两组均与PSM前和后相当，除了慢性心力衰竭,在分流患者中更为普遍(26.1%，在PSM前分析中P=0.036)。关于30天的卒中和Clavien-Dindo评分≥2，没有发现显着关联（P=0.730，P=0.635和P=0.942，P=0.472，相应地，对于PSM之前和之后)。
结论：在这个队列中，对于30天的卒中或Clavien-Dindo≥2的发生率，采用分流术未显示出优势。然而，需要更多更广泛的研究来获得关于颈动脉分流在区域麻醉下的这一部分患者中的准确效用的准确结果.
