{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T09:55:18Z","timestamp":1781517318985,"version":"3.54.1"},"reference-count":18,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T00:00:00Z","timestamp":1781395200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: The objectives of this study were to characterise induction-phase regional cerebral oxygen saturation (rSO2)\u2013mean arterial pressure (MAP) dynamics during near-infrared spectroscopy (NIRS)-guided selective carotid endarterectomy (CEA) and to examine whether the Awake\u2192Intubated pressure\u2013oxygenation 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 \u226570% 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\u2192Intubated ipsilateral \u0394rSO2\/\u0394MAP was evaluated as a continuous, exploratory pressure\u2013oxygenation index, with MAP\u2013rSO2 directional change classified as concordant or discordant. Clamp-related desaturation was defined as a \u226520% 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 \u226520% ipsilateral rSO2 desaturation occurred in 43 patients (13.4%). The Awake\u2192Intubated ipsilateral \u0394rSO2\/\u0394MAP ratio differed significantly between patients with and without \u226520% desaturation and showed significant discrimination on receiver operating characteristic analysis, with an area under the curve (AUC) of 0.799 (95% confidence interval [CI] 0.723\u20130.876; p &lt; 0.001). Concordant pressure\u2013oxygenation change was more frequent among patients with \u226520% desaturation (31\/43, 72.1%), whereas discordant change predominated among those without desaturation (228\/279, 81.7%; p &lt; 0.001). In multivariable analysis, Awake\u2192Intubated ipsilateral \u0394rSO2\/\u0394MAP remained associated with clamp-related \u226520% desaturation after adjustment (adjusted odds ratio [OR] 1.63, 95% CI 1.15\u20132.33; p = 0.006), along with symptomatic presentation and 50\u201369% contralateral stenosis. Postoperative stroke occurred in 4\/322 patients (1.2%), and no 30-day mortality occurred. Conclusions: During NIRS-guided selective CEA, induction-phase rSO2\u2013MAP dynamics were associated with subsequent cross-clamp-related ipsilateral cerebral desaturation. As the outcome was a NIRS-defined desaturation rather than an independent clinical, neurological, or imaging endpoint, these findings indicate association with a surrogate marker rather than prediction of clinically relevant cerebral ischaemia. The Awake\u2192Intubated \u0394rSO2\/\u0394MAP ratio and directional pressure\u2013oxygenation pattern may represent early adjunctive physiological signals associated with clamp-related desaturation. These findings are hypothesis-generating and require prospective validation with systematic multimodal monitoring.<\/jats:p>","DOI":"10.3390\/jcm15124620","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T08:57:58Z","timestamp":1781513878000},"page":"4620","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Induction-Phase rSO2\u2013MAP Behaviour and Cross-Clamp Desaturation in NIRS-Guided Selective Carotid Endarterectomy: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4197-3381","authenticated-orcid":false,"given":"Ilhan","family":"Ozgol","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Prof. Dr. Cemil Tasc\u0131oglu City Hospital, Dar\u00fclaceze Avenue No: 27, Kaptanpa\u015fa District, \u015ei\u015fli, 34384 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1528-6788","authenticated-orcid":false,"given":"Serkan","family":"Ketenciler","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Prof. Dr. Cemil Tasc\u0131oglu City Hospital, Dar\u00fclaceze Avenue No: 27, Kaptanpa\u015fa District, \u015ei\u015fli, 34384 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cihan","family":"Yucel","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Prof. Dr. Cemil Tasc\u0131oglu City Hospital, Dar\u00fclaceze Avenue No: 27, Kaptanpa\u015fa District, \u015ei\u015fli, 34384 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melek","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Prof. Dr. Cemil Tasc\u0131oglu City Hospital, Dar\u00fclaceze Avenue No: 27, Kaptanpa\u015fa District, \u015ei\u015fli, 34384 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasar","family":"Gokkurt","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Prof. Dr. Cemil Tasc\u0131oglu City Hospital, Dar\u00fclaceze Avenue No: 27, Kaptanpa\u015fa District, \u015ei\u015fli, 34384 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5834-2455","authenticated-orcid":false,"given":"Ahmet Ozan","family":"Koyuncu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Prof. Dr. Cemil Tasc\u0131oglu City Hospital, Dar\u00fclaceze Avenue No: 27, Kaptanpa\u015fa District, \u015ei\u015fli, 34384 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asime","family":"Ay","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Reanimation, Prof. Dr. Cemil Ta\u015f\u00e7\u0131o\u011flu City Hospital, \u015ei\u015fli, 34384 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5208-0626","authenticated-orcid":false,"given":"Mehmet Ali","family":"Yesiltas","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, ISTUN Sisli Kolan Internat\u0131onal Hospital, 34384 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2456-3206","authenticated-orcid":false,"given":"Cennet","family":"Yildiz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bak\u0131rk\u00f6y Dr. Sadi Konuk Training and Research Hospital, 34147 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.ejvs.2022.04.011","article-title":"Editor\u2019s Choice\u2014European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease","volume":"65","author":"Naylor","year":"2023","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1056\/NEJMe1600123","article-title":"Endarterectomy, stenting, or neither for asymptomatic carotid-artery stenosis","volume":"374","author":"Spence","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1161\/01.STR.0000059381.17983.77","article-title":"Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting)","volume":"34","author":"Bond","year":"2002","journal-title":"Stroke"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/j.ejvs.2013.07.007","article-title":"Near-infrared spectroscopy to indicate selective shunt use during carotid endarterectomy","volume":"46","author":"Pennekamp","year":"2013","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.avsg.2022.08.015","article-title":"A systematic review and meta-analysis on perioperative cerebral and hemodynamic monitoring methods during carotid endarterectomy","volume":"88","author":"Vuurberg","year":"2023","journal-title":"Ann. Vasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.ejvs.2022.08.025","article-title":"Comparison of Methods for Monitoring Intra-operative Cerebral Perfusion in Patients Undergoing Carotid Endarterectomy with Selective Shunting: A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials and Cohort Studies","volume":"65","author":"Jovanovic","year":"2023","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.ejvs.2021.08.022","article-title":"Overview and diagnostic accuracy of near infrared spectroscopy in carotid endarterectomy: A systematic review and meta-analysis","volume":"62","author":"Khan","year":"2021","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2818","DOI":"10.1161\/STROKEAHA.107.485706","article-title":"Continuous time-domain analysis of cerebrovascular autoregulation using near-infrared spectroscopy","volume":"38","author":"Brady","year":"2007","journal-title":"Stroke"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1161\/STROKEAHA.109.575159","article-title":"Real-time continuous monitoring of cerebral blood flow autoregulation using near-infrared spectroscopy in patients undergoing cardiopulmonary bypass","volume":"41","author":"Brady","year":"2010","journal-title":"Stroke"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.avsg.2019.03.021","article-title":"Outcome of near-infrared spectroscopy-guided selective shunting during carotid endarterectomy in general anesthesia","volume":"61","author":"Kondov","year":"2019","journal-title":"Ann. Vasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1152\/physrev.00022.2020","article-title":"Regulation of cerebral blood flow in humans: Physiology and clinical implications of autoregulation","volume":"101","author":"Claassen","year":"2021","journal-title":"Physiol. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1161\/01.STR.28.7.1340","article-title":"Impaired dynamic cerebral autoregulation in carotid artery stenosis","volume":"28","author":"White","year":"1997","journal-title":"Stroke"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1177\/0963689718817760","article-title":"The efficacy of near-infrared spectroscopy monitoring in carotid endarterectomy: A prospective, single-center, observational study","volume":"28","author":"Wang","year":"2019","journal-title":"Cell Transplant."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.athoracsur.2008.08.070","article-title":"Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery","volume":"87","author":"Slater","year":"2009","journal-title":"Ann. Thorac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Russo, M.F., Gentile, P., Fenga, M., Izzo, S., Denaro, F., Luka, K., Frattaroli, F., Costanzo, A., Castagneto-Gissey, L., and Salvati, B. (2023). Cerebral oximetry monitoring by means of INVOS-4100 as a predictor of ischemic events during carotid endarterectomy. Front. Surg., 10.","DOI":"10.3389\/fsurg.2023.1170019"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Jia, Y., Feng, G., Wang, Z., Feng, Y., Jiao, L., and Wang, T.L. (2022). Prediction of risk factors for intraoperative hypotension during general anesthesia undergoing carotid endarterectomy. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.890107"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/bja\/aem137","article-title":"Carotid endarterectomy","volume":"99","author":"Howell","year":"2007","journal-title":"Br. J. Anaesth."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.avsg.2022.03.030","article-title":"Peri-procedural management of hemodynamic instability in patients undergoing carotid revascularization","volume":"85","author":"Reslan","year":"2022","journal-title":"Ann. Vasc. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4620\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T09:43:46Z","timestamp":1781516626000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4620"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,14]]},"references-count":18,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124620"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124620","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,14]]}}}