THE VALUE OF CAROTID STUMP PRESSURE AND EEG MONITORING IN PREDICTING CAROTID CROSS-CLAMPING INTOLERANCE

The authors analyse their experience with carotid stump pressure (CSP) and electro-encephalogram (EEG) monitoring in relation to the inciden ce of peroperative stroke during internal carotid artery reconstructio n. A series of 215 patients is presented, among whom six (2.8%) develo ped a peroperative stroke. The stroke rate in patients with a CSP belo w 50 mm Hg (n=92) was 7% (2/27) without a shunt and 3% (2/62) with the use of a shunt. The respective numbers for patients with a CSP equal to or above 50 mmHg were 1.7% (2/123) and 0% (0/10). The EEG remained normal after cross clamping in 180 cases (84%):the incidence of stroke was 1.5% (2/138) without and 5% (2/42) with a shunt. A shunt was used in 33 of the 35 patients with EEG changes after cross clamping. None of them sustained a stroke in contrast to both patients where despite EEG changes no shunt was used (respective stroke rates 0% and 100%). I t is concluded that regarding cerebral function, EEG monitoring provid es more accurate information than CSP.