Predictors of cerebral complications during carotid endarterectomy

Objective. To evaluate the prognostic value of parameters of cerebral oxygenation in estimation of the risk of ischemic stroke (IS) in perioperative and early postoperative phase of carotid endarterectomy (CEE). Material and methods. Four hundred and sixty-six patients with hemodynamically significant atherosclerotic lesion of arteries of the brachiocephalic system, who underwent CEE with bilateral monitoring of cerebral oxygenation (rSO₂), were enrolled. The end-point of the study was cerebral complications in perioperative and early postoperative phase. Results. The perioperative level of rSO₂ <50% (AUC 0.85 (0.73—0.96), p<0.05) and the reduction in rSO₂ in the operated side during the temporary occlusion of the inner carotid artery (ICA) by ≥20% (AUC 0.74 (0.51—0.97) p<0.05) were the best predictors of the risk of IS. The risk group with the reduction in rSO2 by ≥20% at the main stage of CEE included patients with collateral stenosis and ICA occlusion, occlusion of the circle of Willis and the history of myocardial infarction. Conclusion. The reduction in rSO₂ in the stage of ICA occlusion by ≥20% increased the risk of IS by >10 times, the perioperative level of rSO₂ <50% increased the risk of IS in perioperative and early postoperative phase of CEE by 6 times.