Carotid Endarterectomy Surgeries: A Multimodality Intraoperative Neurophysiological Monitoring Approach.
carotid
carotid endarterectomy
electroencephalography
ionm
neuromonitoring
neurophysiology
somatosensory evoked potentials
stroke
tcd
transcranial doppler ultrasound
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
Jul 2022
Jul 2022
Historique:
accepted:
04
07
2022
entrez:
8
8
2022
pubmed:
9
8
2022
medline:
9
8
2022
Statut:
epublish
Résumé
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.
Identifiants
pubmed: 35936121
doi: 10.7759/cureus.26556
pmc: PMC9348437
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e26556Informations de copyright
Copyright © 2022, Jahangiri et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
J Biomed Res. 2010 Nov;24(6):460-6
pubmed: 23554663
Lancet Neurol. 2010 Jul;9(7):663-71
pubmed: 20554250
Acta Neurochir (Wien). 2021 Jun;163(6):1799-1805
pubmed: 33099692
World Neurosurg. 2015 Dec;84(6):1941-9.e1
pubmed: 26341440
J Clin Monit Comput. 2009 Dec;23(6):369-90
pubmed: 19757102
Stroke. 1999 Sep;30(9):1751-8
pubmed: 10471419
J Vasc Surg. 2015 Jan;61(1):103-11
pubmed: 25065581
Neurology. 2021 Nov 16;97(20 Suppl 2):S6-S16
pubmed: 34785599
Stroke. 1995 Jan;26(1):188-201
pubmed: 7839390
J Neuroimaging. 2022 May 19;:
pubmed: 35589555
Stroke. 1986 Sep-Oct;17(5):891-7
pubmed: 3764960
Lancet. 2021 Sep 18;398(10305):1065-1073
pubmed: 34469763
Eur J Vasc Endovasc Surg. 2015 Sep;50(3):281-8
pubmed: 26160210
Neurosurg Clin N Am. 1996 Oct;7(4):693-702
pubmed: 8905780
J Ultrasound Med. 2017 Mar;36(3):621-630
pubmed: 28127789
J Vasc Surg. 2018 Jan;67(1):191-198
pubmed: 28688529
J Clin Monit Comput. 2021 Dec;35(6):1429-1436
pubmed: 33389357
Stroke. 2003 Mar;34(3):824-5
pubmed: 12624319
JAMA. 2019 Dec 17;322(23):2313-2322
pubmed: 31846015
J Vasc Surg. 1995 Jun;21(6):963-9
pubmed: 7776476