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 (21)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Joseph P. Archie, Jr, PhD, MD; Robert W. Feldtman, MD

Arch Surg. 1982;117(3):319-322.

Abstract
• To define cerebral perfusion pressure during carotid clamping, carotid back and jugular venous pressures were measured in 100 consecutive carotid endarterectomies in 92 patients. The mean ± 1 SD was 40.5 ± 16.0 mm Hg for carotid back pressure, 11.8 ± 4.8 mm Hg for jugular venous pressure, and 28.7 ± 15.4mm Hg for cerebral perfusion pressure. A number of variables affect jugular venous pressure, including jugular vein compression, patient position, and the anesthetic type. The lower the carotid back pressure, the more likely that back pressure alone is a poor determinant of cerebral perfusion pressure and, hence, of the adequacy of collateral cerebral blood flow. To accurately use the carotid back or stump pressure method, the jugular venous pressure must also be measured, and the cerebral perfusion pressure must be calculated. Based on established safe levels of cerebral blood flow, it is probable that patients who undergo a carotid endarterectomy with a cerebral perfusion pressure of less than 18 mm Hg have cerebral ischemia and may require a shunt. Selective shunting, based on the cerebral perfusion pressure, gave a 1% mortality and 2% permanent neurologic deficit in this series.

(Arch Surg 1982;117:319-322)

Author Affiliations
From the Department of Surgery, Baylor College of Medicine, Houston (Dr Feldtman). Dr Archie is in private practice in Raleigh, NC.

Footnotes
Accepted for publication June 1, 1981.

Read in part before the 63rd annual Clinical Congress of the American College of Surgeons, Dallas, Oct 17, 1977.

Reprints not available.

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

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Occlusion and Shunt Times for Carotid Endarterectomy with Primary Closure, Patch Angioplasty, and Adjunctive Reconstructive Procedures
Archie
VASC ENDOVASCULAR SURG 1999;33:141-150.
ABSTRACT  

Arterial Autograft for Carotid Replacement During Head and Neck Cancer Surgery
Tagett et al.
VASC ENDOVASCULAR SURG 1996;30:505-510.
ABSTRACT  

Recent Gross Intramural Plaque Hemorrhage in Asymptomatic High-Grade Carotid Stenosis
Archie
VASC ENDOVASCULAR SURG 1989;23:355-359.
ABSTRACT