Arterial collateral anatomy predicts the risk for intra-operative changes in somatosensory evoked potentials in patients undergoing carotid endarterectomy: a prospective cohort study.

Müller, Mandy D.; Seidel, Kathleen; Peschi, Giovanni; Piechowiak, Eike; Mosimann, Pascal J.; Schucht, Philippe; Raabe, Andreas; Bervini, David (2021). Arterial collateral anatomy predicts the risk for intra-operative changes in somatosensory evoked potentials in patients undergoing carotid endarterectomy: a prospective cohort study. Acta neurochirurgica, 163(6), pp. 1799-1805. Springer Vienna 10.1007/s00701-020-04624-y

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BACKGROUND

During carotid endarterectomy (CEA), significant amplitude decrement of somatosensory evoked potentials (SEPs) is associated with post-operative neurological deficits.

OBJECTIVE

To investigate the association between an incomplete circle of Willis and/or contralateral ICA occlusion and subsequent changes in intra-operatively monitored SEPs.

METHODS

We performed a retrospective analysis of a single center, prospective cohort of consecutive patients undergoing CEA over a 42-month period after reviewing the collateral arterial anatomy on pre-operative radiological imaging. The primary endpoint was an intra-operative decline in SEPs > 50% compared to the baseline value during arterial cross-clamping. Univariate and multivariate logistic regression analyses were performed to investigate a potential association between contralateral ICA occlusion, incomplete circle of Willis, and subsequent alteration in SEPs.

RESULTS

A total of 140 consecutive patients were included, of which 116 patients (82.9%) had symptomatic carotid stenosis of at least 50% according to the classification used in the North American Carotid Surgery Trial (NASCET) (Stroke 22:711-720, 1991). Six patients (4.3%) showed contralateral ICA occlusion, 22 patients (16%) a missing/hypoplastic anterior communicating artery (Acom) or A1 segment, and 79 patients (56%) a missing ipsilateral posterior communicating artery (Pcom) or P1 segment. ICA occlusion and missing segments of the anterior circulation (missing A1 and/or missing Acom) were associated with the primary endpoint (p = 0.003 and p = 0.022, respectively).

CONCLUSION

Contralateral ICA occlusion and missing anterior collaterals of the circle of Willis increase the risk of intra-operative SEP changes during CEA. Pre-operative assessment of collateral arterial anatomy might help identifying patients with an increased intra-operative risk.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Müller, Mandy; Seidel, Kathleen; Peschi, Giovanni; Piechowiak, Eike Immo; Mosimann, Pascal John; Schucht, Philippe; Raabe, Andreas and Bervini, David

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0001-6268

Publisher:

Springer Vienna

Language:

English

Submitter:

Nicole Söll

Date Deposited:

12 Jan 2021 09:43

Last Modified:

14 May 2021 01:32

Publisher DOI:

10.1007/s00701-020-04624-y

PubMed ID:

33099692

Uncontrolled Keywords:

Carotid endarterectomy Cerebrovascular disease Neuromonitoring Risks assessment Surgical morbidity Vascular anatomy

BORIS DOI:

10.48350/149969

URI:

https://boris.unibe.ch/id/eprint/149969

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