Author:
Bevilacqua Sergio,Ticozzelli Giulia,Orso Massimiliano,Alba Giuseppe,Capoccia Laura,Cappelli Alessandro,Cernetti Carlo,Diomedi Marina,Dorigo Walter,Faggioli Gianluca,Giannace Giovanni,Giannandrea David,Giannetta Matteo,Lessiani Gianfranco,Marone Enrico Maria,Mazzaccaro Daniela,Migliacci Rino,Nano Giovanni,Pagliariccio Gabriele,Petruzzellis Marco,Plutino Andrea,Pomatto Sara,Pulli Raffaele,Sirignano Pasqualino,Vacirca Andrea,Visco Emanuele,Moghadam Shadeh Parsapour,Lanza Gaetano,Lanza Jessica
Abstract
Abstract
Background and aims
In order to systematically review the latest evidence on anesthesia, intraoperative neurologic monitoring, postoperative heparin reversal, and postoperative blood pressure management for carotid endarterectomy. The present review is based on a single chapter of the Italian Health Institute Guidelines for diagnosis and treatment of extracranial carotid stenosis and stroke prevention.
Methods and results
A systematic article review focused on the previously cited topics published between January 2016 and October 2020 has been performed; we looked for both primary and secondary studies in the extensive archive of Medline/PubMed and Cochrane library databases.
We selected 14 systematic reviews and meta-analyses, 13 randomized controlled trials, 8 observational studies, and 1 narrative review. Based on this analysis, syntheses of the available evidence were shared and recommendations were indicated complying with the GRADE-SIGN version methodology.
Conclusions
From this up-to-date analysis, it has emerged that any type of anesthesia and neurological monitoring method is related to a better outcome after carotid endarterectomy. In addition, insufficient evidence was found to justify reversal or no-reversal of heparin at the end of surgery. Furthermore, despite a low evidence level, a suggestion for blood pressure monitoring in the postoperative period was formulated.
Publisher
Springer Science and Business Media LLC