Induction-Phase rSO2–MAP Behaviour and Cross-Clamp Desaturation in NIRS-Guided Selective Carotid Endarterectomy: A Retrospective Cohort Study

作者：Ilhan Ozgol, S. Ketenciler, Cihan Yucel, Melek Yilmaz, Yasar Gokkurt, A. Koyuncu, Asime Ay, M. A. Yeşiltaş, C. Yıldız · 发表于：Journal of Clinical Medicine · 年份：2026 · DOI：10.3390/jcm15124620 · 研究领域：Medicine

Objective: The objectives of this study were to characterise induction-phase regional cerebral oxygen saturation (rSO2)–mean arterial pressure (MAP) dynamics during near-infrared spectroscopy (NIRS)-guided selective carotid endarterectomy (CEA) and to examine whether the Awake→Intubated pressure–oxygenation pattern may represent an early adjunctive physiological signal of subsequent cross-clamp-related ipsilateral cerebral desaturation. Methods: In this retrospective observational cohort study, 322 consecutive elective CEAs managed with an NIRS-guided selective shunting protocol between October 2019 and February 2025 were analysed, after excluding patients considered for routine pre-emptive shunting because of contralateral internal carotid artery occlusion or ≥70% stenosis. Standardised MAP and bilateral rSO2 values were extracted at the Awake, Intubated, and Clamp stages, defined as 3 min after carotid cross-clamping. Awake→Intubated ipsilateral ΔrSO2/ΔMAP was evaluated as a continuous, exploratory pressure–oxygenation index, with MAP–rSO2 directional change classified as concordant or discordant. Clamp-related desaturation was defined as a ≥20% ipsilateral rSO2 decrease from Awake to Clamp. Discrimination and adjusted associations were evaluated using receiver operating characteristic analysis and multivariable logistic regression, respectively. Results: Clamp-related ≥20% ipsilateral rSO2 desaturation occurred in 43 patients (13.4%). The Awake→Intubated ipsilateral ΔrSO2/...