1. Multimodal Neurophysiological Monitoring Reduces Shunt Incidence during Carotid Endarterectomy
- Author
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Claudio Martinazzo, Marco Ventura, Marco Leopardi, Aldo Musilli, Annamaria Maggipinto, Alfonso Marrelli, and Elisa Piccolo
- Subjects
Male ,medicine.medical_specialty ,Intraoperative Neurophysiological Monitoring ,Ultrasonography, Doppler, Transcranial ,medicine.medical_treatment ,Blood Pressure ,Carotid endarterectomy ,030204 cardiovascular system & hematology ,Electroencephalography ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Evoked Potentials, Somatosensory ,medicine ,Humans ,Carotid Stenosis ,cardiovascular diseases ,Neurophysiological Monitoring ,Endarterectomy ,Aged ,Retrospective Studies ,Aged, 80 and over ,Endarterectomy, Carotid ,medicine.diagnostic_test ,business.industry ,Retrospective cohort study ,Blood Pressure Determination ,General Medicine ,Middle Aged ,Transcranial Doppler ,Stroke ,Treatment Outcome ,Somatosensory evoked potential ,Ischemic Attack, Transient ,Predictive value of tests ,Cardiology ,Surgery ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
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 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 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 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.
- Published
- 2019