Selective shunting during carotid endarterectomy based on two-channel computerized electroencephalographic/compressed...

Area of Science:

• Neurosurgery
• Neurology
• Medical Devices

Background:

• Selective shunting during carotid endarterectomy aims to prevent cerebral ischemia.
• The reliability of computerized electroencephalogram (EEG) monitoring for guiding selective shunting remains unclear.

Purpose of the Study:

• To evaluate the reliability of a two-channel computerized EEG monitor in guiding selective shunting during carotid endarterectomy.
• To determine the correlation between intraoperative EEG changes and postoperative neurological outcomes.

Main Methods:

• 103 carotid endarterectomies were performed using a two-channel computerized EEG monitor processing raw EEG and compressed spectral array (CSA).
• Ischemic EEG events were identified by amplitude attenuation and/or loss of high-frequency activity.
• Selective shunting was employed based on EEG monitoring findings.

Main Results:

• 14 patients (13.6%) received a bypass shunt.
• 97 patients (94.2%) had intact postoperative neurological examinations.
• A significant correlation was found between cumulative ischemic EEG time and neurological outcomes (P < 0.0001).
• Six postoperative deficits (5.8%) occurred, mostly in patients where shunting was not possible due to late ischemic event detection.

Conclusions:

• Simultaneous monitoring of raw EEG and CSA provides a reliable indicator for selective shunting during carotid cross-clamping.
• This monitoring strategy can help prevent neurological deficits in patients undergoing carotid endarterectomy.