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Quantitative EEG Changes Correlate With Post-Clamp Ischemia During Carotid Endarterectomy
Brad K Kamitaki1, Bin Tu2, Stephen Wong1
1Department of Neurology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A.; and.
Summary
Quantitative electroencephalography (EEG) measures, particularly decreases in alpha, beta, and theta power, effectively detect cerebral ischemia during carotid endarterectomy (CEA). This enhances intraoperative monitoring to prevent strokes.
Area of Science:
- Neuroscience
- Medical Monitoring
- Surgical Procedures
Background:
- Electroencephalography (EEG) monitoring is crucial for detecting cerebral ischemia during carotid endarterectomy (CEA).
- Quantitative EEG (qEEG) analysis offers potential improvements over visual EEG review for identifying ischemia.
- The optimal qEEG parameters for predicting intraoperative ischemia during CEA remain unclear.
Purpose of the Study:
- To identify specific quantitative EEG parameters that reliably detect intraoperative cerebral ischemia during CEA.
- To compare the predictive performance of various qEEG measures against physician assessment.
Main Methods:
- Retrospective analysis of 118 patients undergoing CEA with intraoperative EEG monitoring (2007-2014).
- Two physicians masked to outcomes identified post-clamp ischemia, categorizing patients into ischemic-change and no-ischemic-change groups.
- Evaluation of multiple qEEG parameters including power bands (alpha, beta, theta, delta), ratios (alpha-delta, beta-delta), amplitude-integrated EEG, and spectral edge frequency.
Main Results:
- Fifteen patients (12.7%) were classified in the ischemic-change group.
- Significant decreases in ipsilateral post-clamp trough values were observed across all assessed qEEG measures in the ischemic-change group.
- Reductions in alpha (≥52.1%), beta (≥41.6%), and theta (≥36.4%) power were the most predictive indicators of post-clamp ischemia.
Conclusions:
- Quantitative EEG parameters, especially power band decreases, demonstrate significant predictive value for intraoperative ischemia during CEA.
- Integrating qEEG analysis with visual EEG monitoring can enhance the detection of cerebral ischemia.
- Improved detection of ischemia may lead to a reduction in perioperative strokes following CEA.
