Cerebral protection during carotid endarterectomy
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Published on: May 31, 2024
Nathaniel P Reuter1, Scott D Charette, Robert P Sticca
1Department of Surgery, University of North Dakota School of Medicine and Health Sciences, 501 North Columbia Road, Grand Forks, ND 58203, USA.
Insights
Intraoperative electroencephalogram (EEG) monitoring for carotid endarterectomy may lead to higher stroke rates. Shunting is crucial when EEG changes occur to prevent perioperative neurologic events.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Carotid endarterectomy carries risks of perioperative stroke, with rates of 3.4% for asymptomatic and 5.2% for symptomatic patients.
- Various methods are employed to mitigate stroke risk during and after carotid endarterectomy.
Purpose of the Study:
- To evaluate the effectiveness of different intraoperative monitoring techniques in preventing perioperative stroke during carotid endarterectomy.
- To compare stroke rates associated with electroencephalogram (EEG) monitoring versus stump pressures for guiding shunting decisions.
Main Methods:
- A retrospective chart review of 251 carotid endarterectomies performed between January 2000 and February 2003.
- Data collected included patient demographics, surgical procedures, intraoperative monitoring methods, and patient outcomes.
- Comparative analysis of outcomes based on electroencephalogram (EEG) monitoring and stump pressure monitoring.
Main Results:
- Sixteen neurologic events occurred, including 15 strokes and 1 transient ischemic attack.
- The electroencephalogram (EEG) group experienced 12 strokes, with a 38% event rate in procedures showing EEG changes without shunting.
- The stump pressure group had only one stroke, and the overall stroke rate for intraoperative EEG monitoring was significantly elevated (P = 0.02).
Conclusions:
- Intraoperative EEG-based decisions to shunt may be less effective in preventing perioperative neurologic events compared to other methods.
- Shunting is indicated when electroencephalogram (EEG) changes are detected during carotid endarterectomy to reduce stroke risk.
Background:
Perioperative stroke rates with carotid endarterectomy are 3.4% for asymptomatic and 5.2% for symptomatic patients. Several methods are used to limit perioperative stroke.
Methods:
A retrospective chart review of consecutive carotid endarterectomies from January 1, 2000 to February, 28, 2003, was performed. Data were collected on patient demographics, operative procedure, intraoperative monitoring, and outcome. Comparative analysis of intraoperative monitoring and outcome was performed.
Results:
Two hundred twenty-nine patients underwent 251 carotid endarterectomies. In 196 procedures decision to shunt was based on intraoperative monitoring, 129 by electroencephalogram (EEG), and 67 by stump pressures. Sixteen neurologic events occurred perioperatively, one transient ischemic attack and 15 strokes. The EEG group had 12 strokes, with a 38% event rate in procedures with EEG changes without shunting. The stump pressure group had one stroke. Stroke rate for intraoperative EEG monitoring was elevated (P = 0.02).
Conclusions:
Intraoperative EEG based decision to shunt may not be as effective as other methods for prevention of perioperative neurologic events. When EEG changes occur, shunting is necessary.
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