Preventing renal function impairment perioperative carotid endarterectomy: Analysis, new imaging and operative technique

Abstract

Introduction: Kidney impairment appears to be more common after Carotid artery stenting (CAS) than after carotid endarterectomy (CEA), although few data are available on the CEArelated risk. Therefore, we assessed kidney function in the perioperative CEA period. We also describe our new method for creating useful images without contrast media and an intraoperative CEA technique for preventing renal impairment. Methods: Our study included 244 patients undergoing CEA. We assessed the estimated glomerular filtration rate (eGFR) in the perioperative period, and the endpoint was renal function impairment (RFI: eGFR of more than 20 mL/min/1.73 m2 from the first measurement of eGFR). For patients with prohibited contrast media, we constructed images from computed tomography of the neck and magnetic resonance angiography without contrast media and used an operative technique with a surgical microscope to treat plaques in a high location. Results: The eGFR in the 122 patients undergoing CEA (54.0%) was <60 mL/min/1.73 m2 eGFR at baseline. We found 5 cases of RFI (2.0%), 3 of which were related to contrast media. Three administrations of contrast media was found to be an independent risk factor for RFI. RFI did not occur with any of the procedures performed without contrast media. Conclusion: In perioperative CEA, RFI is rare. Therefore, CEA might be preferable to CAS for preventing RFI. Our new simulation images and our CEA technique for treating plaques in the distal portion of the internal carotid artery might be safe procedures for protecting both cerebral and renal function.

Keywords

• Carotid endarterectomy
• Renal function
• Magnetic resonance image
• Contrast media
• Operative technique