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Related Experiment Video

Updated: Jun 18, 2026

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
09:36

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis

Published on: August 12, 2025

Bispectral index changes in carotid surgery.

M J Estruch-Pérez1, A Ausina-Aguilar, M Barberá-Alacreu

  • 1Anesthesiology and Critical Care Department, Dr. Peset University Hospital, and Department of Preventive Medicine, University of Valencia, Valencia, Spain. estruch_mar@gva.es

Annals of Vascular Surgery
|November 26, 2009
PubMed
Summary

Bispectral index (BIS) monitoring during carotid clamping effectively identifies cerebral ischemia in carotid endarterectomy (CEA) patients. A BIS decrease of 14% or more suggests ischemia is unlikely, aiding intraoperative decision-making.

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Area of Science:

  • Anesthesiology
  • Neurosurgery
  • Neurology

Background:

  • Intraoperative monitoring for cerebral ischemia during carotid endarterectomy (CEA) using shunting is debated.
  • Evaluating the sensitivity and specificity of bispectral index (BIS) changes during carotid clamping is crucial for awake CEA.

Purpose of the Study:

  • To assess BIS changes during carotid clamping in relation to shunting in awake CEA patients.
  • To determine the diagnostic accuracy of BIS monitoring for detecting cerebral ischemia.

Main Methods:

  • Eighty CEAs under cervical block were analyzed, comparing shunted (ischemia signs) and nonshunted patients.
  • BIS values and neurological monitoring were recorded, focusing on carotid clamping.
  • Sensitivity, specificity, and predictive values of BIS decrease during clamping were calculated.

Related Experiment Videos

Last Updated: Jun 18, 2026

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
09:36

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis

Published on: August 12, 2025

Main Results:

  • Shunting was required in 11 patients due to cerebral ischemia.
  • Mean BIS values were significantly lower in shunted (82.82) versus nonshunted (92.31) patients during clamping (p<0.001).
  • A BIS decrease of >=14% showed 81.8% sensitivity and 89.7% specificity for detecting cerebral ischemia.

Conclusions:

  • BIS monitoring is a simple, noninvasive tool for detecting cerebral ischemia during CEA.
  • A BIS decrease >=14% has a high negative predictive value, indicating ischemia is unlikely without it.
  • However, a BIS decrease has a low positive predictive value, not always confirming ischemia.