Operative Factors Associated with the Development of New XXXX During Awake Carotid Endarterectomy.

@entity1 @entity64 @entity734 @entity75
OBJECTIVES: The aim was to analyse a prospective, consecutive series of awake carotid endarterectomy (CEA) @entity1 undergoing, when possible, pre- and postoperative diffusion-weighted magnetic resonance imaging brain scans (DWI). METHODS: All CEA @entity1 from June 23, 2006, to January 13, 2012, were prospectively entered in the study. CEA was performed under regional cervical block. Only @entity1 demonstrating shunt @entity734 were shunted. Before August 7, 2008, all longitudinal endarterectomy had been performed with a vein patch. From that date all CEA were eversions without a patch, except shunted @entity1 who were vein patched. DWI was performed 2 days before and 5 days after (3 Tesla). Scans were reported by MRI-trained radiologists. Logistic regression analysis (LRA) identified predictive variables for MRI changes using backward stepwise elimination of variables with p  >  .05. RESULTS: There was a total of 295 consecutive CEA. There were no deaths but four clinical @entity64 (1.4 %); 89 excluded from DWI leaving 206; of these 27 (13%) developed new @entity75 including four of 57 (7%) in the asymptomatic group and 23 of 149 (15%) symptomatic @entity1 . Nineteen of the 206 (9.2%) were shunted. LRA showed that shunt @entity734 was highly associated with new @entity75 : odds ratio (OR) 6.43; 95% confidence interval (CI) 2.3-17.9; p  <  .001. Both the vein patched, non-shunted group (OR .25; CI 0.09-0.72; p  =  .010) and the eversion (all non-shunted and all non-patched) group (OR 0.05; CI 0.01-0.22; p  <  .001) were associated with a low risk of new lesions, with the eversion group a lower risk than the patched group. CONCLUSIONS: One in every eight CEA @entity1 developed new @entity75 (rate doubled in symptomatic @entity1 ). Shunt @entity734 in conscious CEA @entity1 is highly associated with the development of new @entity75 compared with non-shunted @entity1 . For non-shunted @entity1 the new lesion risk is low, and in those @entity1 the risk in the eversion group is lower than in the patched group.
