• World Neurosurg · Mar 2016

    Locoregional Anesthesia for Carotid Endarterectomy: Identification of Patients with Intolerance to Cross-Clamping.

    • Marcos Dellaretti, Laura T de Vasconcelos, Jules Dourado, Renata F de Souza, Renato R Fontoura, and Atos A de Sousa.
    • Department of Neurosurgery, Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil; Department of Neurosurgery, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Neurosurgery, Hospital Mater Dei, Belo Horizonte, Minas Gerais, Brazil. Electronic address: mdellaretti@mac.com.
    • World Neurosurg. 2016 Mar 1; 87: 61-4.

    ObjectiveDuring carotid endarterectomy (CEA), carotid cross-clamping is performed to allow for artery incision and plaque removal. A small subgroup of patients can tolerate carotid occlusion for only a few seconds, if at all, without presenting neurologic deficit. These patients are described as having ''cross-clamp intolerance.'' The purpose of this study was to demonstrate the safety of locoregional anesthesia in identifying patients with cross-clamp intolerance and factors associated with this condition.MethodsFrom August 2008 to May 2010, 115 consecutive patients were submitted to CEA under locoregional anesthesia at the Santa Casa de Belo Horizonte; the procedure was performed by the main author. Patients who showed intolerance to internal carotid artery (ICA) occlusion for <30 seconds were considered to have cross-clamp intolerance.ResultsAmong the 115 participating patients, 9.6% (11 patients) showed intolerance to ICA occlusion and developed deficits in <30 seconds (i.e., these patients presented cross-clamp intolerance). The factor that was associated with cross-clamp intolerance was the mean degree of contralateral carotid stenosis, which was 57.5% for those who presented intolerance and 27.8% for those who tolerated ICA occlusion.ConclusionLocoregional anesthesia is a safe method for identifying patients with cross-clamp intolerance. Patients with cross-clamp intolerance present contralateral stenosis that is greater on average than patients who readily tolerate carotid artery occlusion.Copyright © 2016 Elsevier Inc. All rights reserved.

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