Turk Gogus Kalp Damar Cerrahisi Derg. 2026 Feb 17. doi: 10.4274/tjtcs.2026.28320. Online ahead of print.
ABSTRACT
BACKGROUND: We aimed to determine the relationship between near-infrared spectroscopy (NIRS) changes and shunt use, and the role of wakefulness in detecting early neurological events during carotid endarterectomy (CEA) surgeries performed under local anesthesia (LA) while the patient was awake.
METHODS: Patients who underwent CEA under LA were included in the study. All data were obtained retrospectively from patient files in our institution’s archives. Shunt use, decreases in NIRS values, internal carotid artery (ICA) closure technique, and clamping time were recorded during the procedure. Patients were divided into two groups: Those with and those without contralateral total occlusion (CTO). These groups were compared in terms of decrease rates in NIRS values and shunt use.
RESULTS: Present study included 635 patients (68% male, mean age: 66.7±5.6 years). One hundred thirty-four (21.1%) of the patients had bilateral ICA stenosis of 70% or greater. The patients were divided into two groups: With and without CTO. CTO was detected in 97 (15.3%) patients. In all groups, shunts were applied to patients with a 30% or more decrease in NIRS values. In the CTO group, percentage decreases in NIRS values were greater and statistically significant (p<0.001), except for decreases below 10% (p<0.001). Shunt usage in the CTO group was found to be statistically significant (p=0.042). However, shunt use was associated with a decrease in NIRS rather than the presence of CTO (r=0.747, p<0.001). The most common complications in the postoperative period were voice disorder and hoarseness at a rate of 20.8%.
CONCLUSION: With carotid surgery performed under LA, significant neurological deficits were detected early and necessary revisions were performed. We also found that a decrease in NIRS values is significant for shunt use, and a decrease of more than 30% in NIRS could be note worthy for shunt use.
PMID:41700460 | DOI:10.4274/tjtcs.2026.28320
