Near-infrared spectroscopy as a predictor of cerebral ischaemia during carotid endarterectomy in awake patients

Objectives The aim of our study was to evaluate the near-infrared spectroscopy monitoring system to detect cerebral ischaemia, find indications for selective shunting during carotid endarterectomy and compare it with an internal carotid artery stump pressure monitoring technique in patients operated under local anaesthesia. Methods During January 2015 and November 2018, 131 patients undergoing carotid endarterectomy under local anaesthesia were prospectively included in the study. Near-infrared spectroscopy as intraoperative monitoring was applied and compared with stump pressure. Results Carotid endarterectomy was performed successfully in 106 patients operated under local anaesthesia. Meanwhile, 25 patients developed neurological changes (motor or consciousness impairment, weakness of extremities, cognitive decline) during clamping, and all of them received a shunt. ΔrSO2, stump pressure and rSO2 (–11 ± 8%, 31 ± 6mmHg, 58 ± 11) values were smaller in the group of shunted subjects versus non-shunted group subjects (–2 ± 5%, 61 ± 17 mmHg, 64 ± 8) after 1 min of internal carotid artery clamping (p