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Continuous electroencephalographic monitoring during carotid endarterectomy
H R McFarland1, J A Pinkerton, D Frye
1Department of Neuroscience, St. Luke's Hospital, Kansas City, Missouri.
Insights
Continuous electroencephalogram monitoring effectively identifies cerebral ischemia during carotid endarterectomy, guiding the need for a carotid shunt. This method proved more reliable than stump pressures for detecting neurological deficits.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Surgery
Background:
- Carotid endarterectomy is a common procedure to prevent stroke.
- Determining the need for a carotid shunt during surgery is crucial to prevent cerebral ischemia.
- Current methods for monitoring cerebral perfusion may have limitations.
Purpose of the Study:
- To evaluate the efficacy of continuous electroencephalography (EEG) in detecting cerebral ischemia during carotid endarterectomy.
- To determine if EEG changes correlate with neurological deficits and the need for a carotid shunt.
- To compare the effectiveness of EEG monitoring with stump pressures in guiding surgical decisions.
Main Methods:
- A retrospective review of 427 carotid endarterectomies performed on 377 patients.
- Electroencephalogram (EEG) was the sole determinant for carotid shunt use in 386 procedures.
- Neurological outcomes and EEG changes were recorded and analyzed.
Main Results:
- Electroencephalographic changes occurred in 13% of cases upon internal carotid artery clamping.
- The most frequent EEG change was rapid, ipsilateral attenuation of background activity (60%).
- Combined morbidity and mortality was 2.8%, with a stroke rate of 2.5%. Neurologic complications increased with contralateral carotid occlusion. EEG correlated with neurological deficits, while stump pressures did not.
Conclusions:
- Continuous EEG monitoring is an effective method for identifying significant cerebral ischemia during carotid endarterectomy.
- EEG monitoring helps determine the necessity of a carotid shunt, thereby potentially reducing neurological complications.
- Stump pressures are not a reliable indicator of cerebral ischemia or neurological deficits during this procedure.
Abstract:
Four hundred and twenty-seven carotid endarteriectomies were performed on 377 patients. The electroencephalogram was used as the sole determinant for the use of a carotid shunt in 386 carotid endarterectomies. With clamping of the internal carotid artery, 51 (13%) had electroencephalographic changes. The most common electroencephalographic change (60%) was rapid, ipsilateral attenuation of background activity. In the 30 day follow up period there were 3 deaths (0.7%) and 11 strokes (2.5%). Two patients (0.5%) had intraoperative strokes. The combined morbidity and mortality was 2.8% (12 of 427). Neurologic complications increased significantly with contralateral carotid occlusion. The electroencephalogram correlated well with neurological deficits occurring in surgery, but stump pressures neither correlated with neurological deficits nor electroencephalographic changes. Continuous electroencephalographic monitoring during carotid endarterectomy is an effective method of determining significant cerebral ischemia and the need for a carotid shunt.