{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T07:03:03Z","timestamp":1776841383888,"version":"3.51.2"},"reference-count":61,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2024,11,23]],"date-time":"2024-11-23T00:00:00Z","timestamp":1732320000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2024,11,23]],"date-time":"2024-11-23T00:00:00Z","timestamp":1732320000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Scand J Surg"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Carotid endarterectomy (CEA) carries a risk of perioperative stroke, particularly during carotid cross-clamping. While neurological monitoring is reliable for patients under regional anesthesia, alternative options are needed for those unsuitable for regional anesthesia. Near-infrared spectroscopy (NIRS) is commonly used during CEA, but its diagnostic accuracy varies, particularly under general anesthesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A systematic review with meta-analysis was performed to assess the diagnostic accuracy of intraoperative NIRS in detecting clamp-associated hemodynamic cerebral ischemia in patients under general anesthesia. MEDLINE, Google Scholar, and Web of Science were searched for studies that compared NIRS with the occurrence of immediate or early postoperative neurological deficits in patients undergoing CEA under GA. Meta-regression was performed to explore causes of heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 28 studies involving 5729 patients were included. The results show that NIRS has a summary sensitivity of 47.5% and a summary specificity of 90.3% in diagnosing clamp-associated cerebral ischemia under general anesthesia, with an area under the ROC curve (AUC-ROC) of 0.85. The presence of a contralateral carotid occlusion (CCO) increased summary sensitivity while smoking history the presence of CCO and smoking history decreased summary specificity. For postoperative stroke prediction, NIRS has a summary sensitivity of 49.5% and summary specificity of 88.5%, with an AUC-ROC of 0.85.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>NIRS is a specific but not highly sensitive tool for detecting cerebral ischemia during CEA, and its use in combination with more sensitive neuromonitoring methods is recommended, in order to guide intraoperative neuroprotective strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/14574969241282611","type":"journal-article","created":{"date-parts":[[2024,11,23]],"date-time":"2024-11-23T05:58:56Z","timestamp":1732341536000},"page":"84-94","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["The diagnostic accuracy of intraoperative near-infrared spectroscopy in carotid artery endarterectomy under general anesthesia: A systematic review with meta-analysis"],"prefix":"10.1177","volume":"114","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9271-1170","authenticated-orcid":false,"given":"Lu\u00eds","family":"Duarte-Gamas","sequence":"first","affiliation":[{"name":"Lu\u00eds Duarte-Gamas Department of Angiology and Vascular Surgery, Centro Hospitalar do T\u00e2mega e Sousa, Avenida do Hospital Padre Am\u00e9rico 210, 4564-007 Guilhufe, Portugal"}]},{"given":"Mariana","family":"Frag\u00e3o-Marques","sequence":"additional","affiliation":[{"name":"Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal"}]},{"given":"Petar","family":"Zlatanovic","sequence":"additional","affiliation":[{"name":"Clinic for Vascular and Endovascular Surgery, University Clinical Centre of Serbia, Belgrade, Serbia"}]},{"given":"Jos\u00e9 P.","family":"Andrade","sequence":"additional","affiliation":[{"name":"Department of Biomedicine\u2014Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal"},{"name":"CINTESIS@RISE, RISE-Health, Unit of Research, Porto, Portugal"}]},{"given":"Jo\u00e3o","family":"Rocha-Neves","sequence":"additional","affiliation":[{"name":"Department of Biomedicine\u2014Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Porto, Portugal"},{"name":"Department of Angiology and Vascular Surgery, Centro Hospitalar Universit\u00e1rio de S\u00e3o Jo\u00e3o, Porto, Portugal"}]}],"member":"179","published-online":{"date-parts":[[2024,11,23]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2022.04.011"},{"key":"e_1_3_2_3_2","article-title":"Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease","volume":"75","author":"AbuRahma AF","year":"2022","unstructured":"AbuRahma AF, Avgerinos ED, Chang RW, et al: Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease. 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