This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (84)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

LTC Robert W. Hobson, II, MC, USA; LTC Creighton B. Wright, MC, USA; MAJ James W. Sublett, MC, USA; LTC C. William Fedde, MC, USA; COL Norman M. Rich, MC, USA

AMA Arch Surg. 1974;109(5):682-687.

Abstract
Internal carotid artery (ICA) back pressure correlates collateral cerebral blood flow, providing a critical pressure necessary for carotid endarterectomy without a shunt. The ICA back pressures were measured in 43 patients undergoing 50 endarterectomies under regional anesthesia. A four-minute ICA test occlusion was used to determine need for shunting. Mean ICA back pressure was 69 ± 2 (SE) mm Hg in 22 procedures (group 1), 34 ± 2 mm Hg in 25 procedures (group 2), and 15 ± 3 mm Hg in three procedures (group 3). Differences between groups were significant (P <.05) without significant (P>.05) differences in systemic pressure. Group 3 patients did not tolerate temporary carotid occlusion, confirming 25 mm Hg as the lower limit of adequate collateral flow. Five patients developed neurological complications, three in group 1 and two in group 2. Embolization may have occurred in two patients. However, some patients require more than minimum collateral flow and consequently need ICA back pressures higher than 25 to 50 mm Hg.

Author Affiliations
From the Peripheral Vascular Surgery Service, Department of Surgery, Walter Reed Army Medical Center, Washington, DC.

Footnotes
Accepted for publication July 16, 1974.

Read before the 22nd scientific meeting of the International Cardiovascular Society, Chicago, June 22, 1974.

Reprint requests to Department of Surgery, Box 257, Walter Reed Army Medical Center, Washington, DC 20012 (Dr. Hobson).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Superficial or deep cervical plexus block for carotid endarterectomy: a systematic review of complications
Pandit et al.
Br J Anaesth 2007;99:159-169.
ABSTRACT | FULL TEXT  

The Influence of Anesthetic Choice on Carotid Endarterectomy Outcome
Corson et al.
Arch Surg 1987;122:807-812.
ABSTRACT  

Noninvasive Conjunctival Oxygen Monitoring During Carotid Endarterectomy
Kram et al.
Arch Surg 1986;121:914-917.
ABSTRACT  

Monitoring of Somatosensory Evoked Responses During Carotid Endarterectomy
Markand et al.
Arch Neurol 1984;41:375-378.
ABSTRACT  

The Collateral Hemispheric Systolic Pressure
Gee et al.
Arch Surg 1983;118:908-912.
ABSTRACT  

Cerebral Protection in Carotid Surgery
Imparato et al.
Arch Surg 1982;117:1073-1078.
ABSTRACT  

Determinants of Cerebral Perfusion Pressure During Carotid Endarterectomy
Archie and Feldtman
Arch Surg 1982;117:319-322.
ABSTRACT  

Extracranial Surgery for the Low-Flow-Endangered Brain
Whitten et al.
Arch Surg 1981;116:1165-1169.
ABSTRACT  

Therapy of Ischemic Cerebrovascular Disease
BYER and EASTON
ANN INTERN MED 1980;93:742-756.
ABSTRACT  

Superior Thyroid Artery Cannulation for Monitoring Carotid Artery Operation
Falor and Hansel
Arch Surg 1976;111:1036-1037.
ABSTRACT