Multimodal Neurophysiological Monitoring Reduces Shunt Incidence during Carotid Endarterectomy.
Aged
Aged, 80 and over
Blood Pressure
Blood Pressure Determination
Carotid Stenosis
/ diagnosis
Electroencephalography
Endarterectomy, Carotid
/ adverse effects
Evoked Potentials, Somatosensory
Female
Humans
Intraoperative Neurophysiological Monitoring
/ methods
Ischemic Attack, Transient
/ etiology
Male
Middle Aged
Predictive Value of Tests
Retrospective Studies
Risk Factors
Stroke
/ etiology
Treatment Outcome
Ultrasonography, Doppler, Transcranial
Journal
Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
received:
22
02
2019
revised:
05
04
2019
accepted:
06
04
2019
pubmed:
25
7
2019
medline:
10
3
2020
entrez:
24
7
2019
Statut:
ppublish
Résumé
The use of shunt during carotid surgery is controversial. Different experiences are found in literature with transcranial Doppler (TCD), electroencephalogram (EEG), stump pressure (SP), and somatosensorial evoked potentials (SSEP). We realized a retrospective analysis of patients treated with carotid endarterectomy in our unit in the last 2 years. We use several cerebral monitoring: until 2017 we preferred SP + TCD, and, if not available, EEG. Since 2017 we introduced EEG with SSEP, always in association with SP. We analyzed those 2 groups of patients: before and after introduction of EEG with SSEP. From January 2016 to December 2018 we performed 156 carotid revascularizations. In the first group of 93 patients treated under combined SP + TCD (or EEG), we observed 1 stroke (1.1%) and 2 transient ischemic attacks (TIAs) (2.1%); we selectively used a shunt in 21 cases (22.5%). In the second group, 63 patients had an SP + EEG with SSEP monitoring; we observed 1 stroke (1.5%) and 2 TIAs (3.1%), a shunt was necessary in 12 cases (12.9%). In our experience, EEG with SSEP represents an effective parameter to indicate shunt positioning, as we were able to reduce its use, with the same incidence of stroke and TIA.
Sections du résumé
BACKGROUND
BACKGROUND
The use of shunt during carotid surgery is controversial. Different experiences are found in literature with transcranial Doppler (TCD), electroencephalogram (EEG), stump pressure (SP), and somatosensorial evoked potentials (SSEP).
METHODS
METHODS
We realized a retrospective analysis of patients treated with carotid endarterectomy in our unit in the last 2 years. We use several cerebral monitoring: until 2017 we preferred SP + TCD, and, if not available, EEG. Since 2017 we introduced EEG with SSEP, always in association with SP. We analyzed those 2 groups of patients: before and after introduction of EEG with SSEP.
RESULTS
RESULTS
From January 2016 to December 2018 we performed 156 carotid revascularizations. In the first group of 93 patients treated under combined SP + TCD (or EEG), we observed 1 stroke (1.1%) and 2 transient ischemic attacks (TIAs) (2.1%); we selectively used a shunt in 21 cases (22.5%). In the second group, 63 patients had an SP + EEG with SSEP monitoring; we observed 1 stroke (1.5%) and 2 TIAs (3.1%), a shunt was necessary in 12 cases (12.9%).
CONCLUSIONS
CONCLUSIONS
In our experience, EEG with SSEP represents an effective parameter to indicate shunt positioning, as we were able to reduce its use, with the same incidence of stroke and TIA.
Identifiants
pubmed: 31336166
pii: S0890-5096(19)30470-4
doi: 10.1016/j.avsg.2019.04.017
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
178-184Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.