Key result
A multimodality intraoperative neurophysiological monitoring approach utilizing SSEP, EEG, and TCD provides a reliable means of determining the need for selective shunting and minimizing perioperative stroke risk during carotid endarterectomy.
Why the study?
Does multimodality intraoperative neurophysiological monitoring improve the detection of cerebral ischemia and reduce perioperative stroke risk in patients undergoing carotid endarterectomy?
Does multimodality intraoperative neurophysiological monitoring improve the detection of cerebral ischemia and reduce perioperative stroke risk in patients undergoing carotid endarterectomy?
Utilizing a multimodality intraoperative neuromonitoring approach (SSEP, EEG, TCD) during carotid endarterectomy enhances the detection of cerebral ischemia and optimizes selective shunting to reduce perioperative stroke risk.
Selective EEG-guided shunting may lower perioperative stroke risk in CEA; leaves open need for randomized confirmation before changing practice.
Patients with untreated carotid artery stenosis remain at high risk for stroke. Carotid endarterectomy (CEA) is a surgical procedure for the treatment of symptomatic and severe asymptomatic carotid stenosis. A small percentage of patients who do not have good collateral circulation are at high risk of cerebral ischemia during the cross-clamping of the carotid artery. Aspects of CEA, such as cross-clamping and routine shunting, can also carry the risk of perioperative stroke through dislodgement of emboli causing thrombosis, therefore, selective shunting is highly recommended during the CEA procedure. A multimodality approach of intraoperative neurophysiological monitoring (IONM) techniques such as somatosensory evoked potential (SSEP) and electroencephalography (EEG) can be used to monitor cerebral perfusion throughout the duration of the surgery and to predict the need for a selective shunt after cross-clamping. Additional use of transcranial Doppler (TCD) in the multimodality approach can aid in visualizing the cerebral blood flow and detecting any microemboli that may also cause a stroke. A multimodality IONM approach has been reported as more sensitive and specific for predicting and minimizing any postoperative neurological deficits.
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Jahangiri et al. (2022) conducted a review in Carotid artery stenosis. Multimodality Intraoperative Neurophysiological Monitoring (SSEP, EEG, TCD) was evaluated. A multimodality intraoperative neurophysiological monitoring approach utilizing SSEP, EEG, and TCD provides a reliable means of determining the need for selective shunting and minimizing perioperative stroke risk during carotid endarterectomy.
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