| 경동맥 내막절제술에서 뇌파와
Stump Pressure를 이용한 Shunt 삽입 결정 |
| 신원철, 황은구*·이형길 ·강현오 ·이태규 ·장대일 ·정경천 ·최인석*·박주철* |
| 경희대학교 의과대학 신경과학교실,흉부외과학교실* |
| Decision of Shunt Insertion Based on Electroencephalography
and Stump Pressure During Carotid Endarterectomy |
| Won Chul Shin, M.D., Hwang Eun Gu, M.D.*, Hyung Kil Lee, M.D., Hyun Oh Kang, M.D.,
Te Gyu Lee, M.D., Dae-Il Chang, M.D., Kyung-Cheon Chung, M.D., In Suk Choi, M.D.*, Joo Chul Park, M.D.* |
| Department of Neurology, Department of Thoracic Surgery*, College of Medicine, Kyung Hee University |
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| Abstract |
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Background : Carotid endarterectomy (CEA) is an effective treatment for the prevention of stroke in patients with high grade carotid stenosis. Electroencephalographic (EEG) monitoring and measurement of stump pressure are the most widely used methods for assessing the risk of cerebral ischemia during CEA. We designed this study to assess the usefulness of EEG and stump pressure for shunt insertion during CEA. Methods : Nineteen patients were enrolled from January, 1996 to April, 1999. We calculated the percent of carotid stenosis in the patients by the NASCET (North American Symptomatic Carotid Endarterectomy Trial) criteria. The inclusion criteria of the CEA were high grade stenosis (>70%), or moderate stenosis (>50%) with ulcerated plaque. Intra-operative monitoring by using stump pres-sure, and an EEG was performed in 19 operations. Results : The number of patients with asymptomatic and sympto-matic carotid stenosis were 6 and 13 respectively. Shunt during the operations was used in 12 patients; nine had both significant EEG changes and low stump pressures, two had only low stump pressure, one patient had only a significant EEG change. The peri-operative complications of mortality and stroke were found in one case. In the other patients, there no stroke recurrences during the mean follow-up period of 24 months. Conclusions : EEG and stump pressure may be useful in deciding shunt insertion during CEA for detecting ischemic changes. J Korean Neurol Assoc 17(6):797~803, 1999 Key Words : Carotid endarterectomy, Electroencephalography, Stump pressure, Shunt |
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