Hemodynamic Management Using Regional Cerebral Oxygen Monitoring to Reduce Stroke Risk After Carotid Endarterectomy

What this Trial Is About

Researchers are studying the impact of monitoring cerebral autoregulation function using regional cerebral oxygen saturation on postoperative neurological complications in patients undergoing carotid endarterectomy CEA. This surgery treats symptomatic narrowing of the extracranial internal carotid artery but carries a risk of silent strokes detected by MRI shortly after the operation. The study aims to see if real-time monitoring of cerebral oxygen index, which reflects autoregulation, can reduce ischemic brain injury around the time of surgery. Participants are randomly assigned to one of two groups. In the autoregulation group, anesthesiologists maintain the cerebral oxygen index below 0.3 by adjusting blood pressure with norepinephrine or phenylephrine infusions or by modifying oxygen and carbon dioxide levels to improve brain oxygen saturation. In the routine care group, anesthesiologists do not see the cerebral oxygen index and manage blood pressure within 20% of baseline using similar vasoactive drugs, while keeping carbon dioxide and oxygen levels within standard ranges. During the study, participants are evaluated for cerebral ischemic events within 3 days after surgery, with additional assessments including delirium during the first 3 days, cognitive tests before surgery and about 4 to 5 days after surgery, and pain levels at 24, 48, and 72 hours post-surgery. The study enrolls adults aged 18 to 80 scheduled for elective CEA and monitors them closely with brain oxygenation and clinical assessments to understand how cerebral autoregulation management affects recovery and complications.

Association Between Local Cerebral Oxygenation Monitoring and Postoperative Stroke in Carotid Endarterectomy