Somatosensory-evoked potentials during carotid artery surgery: experience in 400 operations

A prospective study was undertaken to determine the efficacy of monitoring somatosensory-evoked potentials (SEP) during carotid artery surgery in predicting a new ischemic neurologic deficit. Three hundred seventy-six patients underwent 400 reconstructions of the internal carotid artery. The mortality rate of the entire series was 0.8%. In 383 procedures, SEP amplitudes were always present during cross-clamping of the internal carotid artery. In spite of that, three neurologic deficits occurred, but all were associated with technical failures and not related to clamping ischemia. Complete loss of SEP amplitudes was noted in 17 procedures. Five of seven patients without an indwelling shunt showed a neurologic deficit after surgery, whereas shunt insertion in 10 resulted in three neurologic deficits. It is concluded that at present SEP recording is an accurate monitoring method in detecting clamping-related cerebral ischemia during carotid artery surgery.