Somatosensory Evoked Potential and Transcranial Doppler Monitoring to Guide Shunting in Carotid Endarterectomy.

Seidel, Kathleen; Jeschko, Johannes; Schucht, Philippe; Bervini, David; Fung, Christian; Krejci, Vladimir; Z'Graggen, Werner Josef; Fischer, Urs; Arnold, Marcel; Goldberg, Johannes; Raabe, Andreas; Beck, Jürgen (2021). Somatosensory Evoked Potential and Transcranial Doppler Monitoring to Guide Shunting in Carotid Endarterectomy. Journal of neurological surgery. Part A, Central European neurosurgery, 82(4), pp. 299-307. Thieme 10.1055/s-0039-1698441

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OBJECTIVE

Clamping of the internal carotid artery (ICA) during carotid endarterectomy (CEA) is a critical step. In our neurosurgical department, CEAs are performed with transcranial Doppler (TCD) and somatosensory evoked potential (SEP) monitoring with a 50% flow velocity/amplitude decrement warning criteria for shunting. The aim of our study was to evaluate our protocol with immediate neurologic deficits after surgery for the primary end point.

METHODS

This is a single-center retrospective cohort study of symptomatic and asymptomatic ICA stenosis patients from January 2012 to June 2015. Only those cases in which CEA was performed with both modalities (TCD and SEP) were included. The Mann-Whitney U test was applied to evaluate TCD and SEP ratios based on immediate postoperative neurologic deficits.

RESULTS

A total of 144 patients were included, 120 (83.3%) with symptomatic ICA stenosis. The primary end point was met by six patients (4.2%); all of them were patients with a symptomatic ICA stenosis. The stroke and death rate was 1.4%. Ratios of SEP amplitudes demonstrated significant differences between patients with and without an immediate postoperative neurologic deficit at the time of ICA clamping (p = 0.005), ICA clamping at 10 minutes (p = 0.044), and ICA reperfusion (p = 0.005). Ratios of TCD flow velocity showed no significant difference at all critical steps.

CONCLUSION

In this retrospective series of simultaneous TCD and SEP monitoring during CEA surgery of predominantly symptomatic ICA stenosis patients, the stroke and death rate was 1.4%. SEP seemed to be superior to TCD in predicting the need for an intraoperative shunt and for predicting temporary postoperative deficits. Further prospective studies are needed.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy 04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology 04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
UniBE Contributor:	Seidel, Kathleen, Schucht, Philippe, Bervini, David, Fung, Christian, Krejci, Vladimir, Z'Graggen, Werner Josef, Fischer, Urs Martin, Arnold, Marcel, Goldberg, Johannes, Raabe, Andreas, Beck, Jürgen
Subjects:	600 Technology > 610 Medicine & health
ISSN:	2193-6315
Publisher:	Thieme
Language:	English
Submitter:	Nicole Söll
Date Deposited:	22 Apr 2020 14:56
Last Modified:	02 Mar 2023 23:33
Publisher DOI:	10.1055/s-0039-1698441
PubMed ID:	31935785
URI:	https://boris.unibe.ch/id/eprint/142177