• Oksana V Kamenskaya, Irina Yu Loginova, and Vladimir V Lomivorotov.
• Clinical Physiology Group, Research Institute of Circulation Pathology, Novosibirsk, Russia.
• J. Cardiothorac. Vasc. Anesth. 2017 Jun 1; 31 (3): 944-949.

ObjectiveTo determine whether preoperative regional cerebral oxygen saturation (rSO2) and the decrease in rSO2 during carotid clamping were predictive of the risk for neurologic complications in carotid endarterectomy and to determine the cutoff values of the studied parameters.DesignCohort, prospective, nonrandomized trial.SettingResearch Institute of Circulation Pathology, Novosibirsk, Russia.ParticipantsThe study comprised 466 adults who underwent carotid endarterectomy since 2012.InterventionsNone.Measurements And Main ResultsPatient characteristics, postoperative complications, and brain oxygen supply during carotid endarterectomy were analyzed. The primary endpoints were the perioperative and early postoperative neurologic complications. Ischemic stroke was diagnosed in 1.5% of patients, and cognitive disorders were reported in 2.6% of patients. Preoperative rSO2 of 50% was the cutoff value for the prediction of stroke outcome after carotid endarterectomy, with a sensitivity of 90.7% and specificity of 66.7%. A 20% decrease in rSO2 during temporary carotid clamping was the cutoff value for the prediction of stroke, with a sensitivity of 86.0% and specificity of 57.1%, and for the prediction of cognitive disorders, with a sensitivity of 88.1% and specificity of 58.3%. Preoperative rSO2 less than 50% and a decrease in rSO2 of at least 20% during temporary carotid artery clamping caused a significant increase in the hospitalization period.ConclusionsA 20% or more decrease in rSO2 during temporary internal carotid artery clamping during carotid endarterectomy caused a 10-fold increased risk of ischemic stroke and an 8-fold increased risk of cognitive disorders, whereas preoperative rSO2 less than 50% resulted in a 6-fold increased risk of ischemic stroke in the perioperative and early postoperative periods of carotid endarterectomy.Copyright © 2017 Elsevier Inc. All rights reserved.

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