Multimodal monitoring in carotid endarterectomy

Patients with carotid artery stenosis have high risk of ischemic stroke. Carotid endarterectomy is the method of choice for ischemic stroke prevention in patients with symptomatic and asymptomatic carotid artery stenosis. Such stages of carotid endarterectomy as selection, artery clamping, and placement of a temporary intraluminal shunt can be accompanied by ischemic complications due to embolism and insufficient collateral blood flow. Multimodal intraoperative neurophysiological monitoring consisting of cerebral oximetry, somatosensory and motor evoked potentials monitoring,electroencephalography, and transcranial Doppler ultrasound allows to perform direct and indirect monitoring of cerebral perfusion during the whole surgery and can be used for prediction of surgical outcomes. Multimodal approach to intraoperative neurophysiological monitoring is the most sensitive and specific approach for predicting and minimizing postoperative neurologic deficit.