The diagnostic accuracy of intraoperative near-infrared spectroscopy in carotid artery endarterectomy under general anesthesia: A systematic review with meta-analysis

Data de publicação: 01/01/2024 Data Ahead of Print: 01/11/2024

Autores da FMUP

João Manuel Palmeira Rocha Neves

Autor

Participantes de fora da FMUP

Duarte-Gamas L.
Fragão-Marques M.
Zlatanovic P.
Andrade J.P.

Unidades de investigação

Biomedicina

Abstract

Background: Carotid endarterectomy (CEA) carries a risk of perioperative stroke, particularly during carotid cross-clamping. While neurological monitoring is reliable for patients under regional anesthesia, alternative options are needed for those unsuitable for regional anesthesia. Near-infrared spectroscopy (NIRS) is commonly used during CEA, but its diagnostic accuracy varies, particularly under general anesthesia. Methods: A systematic review with meta-analysis was performed to assess the diagnostic accuracy of intraoperative NIRS in detecting clamp-associated hemodynamic cerebral ischemia in patients under general anesthesia. MEDLINE, Google Scholar, and Web of Science were searched for studies that compared NIRS with the occurrence of immediate or early postoperative neurological deficits in patients undergoing CEA under GA. Meta-regression was performed to explore causes of heterogeneity. Results: A total of 28 studies involving 5729 patients were included. The results show that NIRS has a summary sensitivity of 47.5% and a summary specificity of 90.3% in diagnosing clamp-associated cerebral ischemia under general anesthesia, with an area under the ROC curve (AUC-ROC) of 0.85. The presence of a contralateral carotid occlusion (CCO) increased summary sensitivity while smoking history the presence of CCO and smoking history decreased summary specificity. For postoperative stroke prediction, NIRS has a summary sensitivity of 49.5% and summary specificity of 88.5%, with an AUC-ROC of 0.85. Conclusions: NIRS is a specific but not highly sensitive tool for detecting cerebral ischemia during CEA, and its use in combination with more sensitive neuromonitoring methods is recommended, in order to guide intraoperative neuroprotective strategies. © The Finnish Surgical Society 2024.

Dados da publicação

ISSN/ISSNe:: 1799-7267, 1457-4969
Tipo:: Review
Páginas:: -
DOI:: 10.1177/14574969241282611
PubMed:: 39579015
Link para outro recurso:: www.scopus.com

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Duarte-Gamas L.:: Luís Duarte, Gamas Department of Angiology and Vascular Surgery, Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, Guilhufe, 4564-007, Portugal
Fragão-Marques M.:: Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
Zlatanovic P.:: Clinic for Vascular and Endovascular Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
Andrade J.P.:: Luís Duarte, Gamas Department of Angiology and Vascular Surgery, Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, Guilhufe, 4564-007, Portugal

Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal

Department of Biomedicine—Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal

CINTESIS@RISE, RISE-Health, Unit of Research, Porto, Portugal
Rocha-Neves J.:: Luís Duarte, Gamas Department of Angiology and Vascular Surgery, Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo 210, Guilhufe, 4564-007, Portugal

Clinic for Vascular and Endovascular Surgery, University Clinical Centre of Serbia, Belgrade, Serbia

Department of Biomedicine—Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal

Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal

Keywords

Carotid endarterectomy; general anesthesia; near-infrared spectroscopy; neurological monitoring

Campos de Estudo

Financiamento

Fundação para a Ciência e a Tecnologia

Fundação para a Ciência e a Tecnologia ((UIDB/4255/2020)

Fundação para a Ciência e a Tecnologia (LA/P/0053/2020))