Article Text
PDF
Abstract
Background In recent years, transcarotid artery revascularization (TCAR) has emerged as a safe and effective alternative to carotid artery stenting. While intraoperative neuromonitoring (IONM) techniques such as electroencephalogram (EEG) and somatosensory evoked potentials (SSEPs) are often employed during TCAR, there is limited research on their diagnostic accuracy.
Methods The authors retrospectively reviewed a multi-institutional IONM database of TCAR procedures performed with EEG and SSEP monitoring. A total of 516 TCAR procedures were included in this study. Significant changes in EEG and/or SSEPs, surgeon’s interventions, resolution of significant changes, and immediate postoperative neurological outcome were documented. Sensitivity, specificity, positive and negative predictive values were calculated.
Results The incidence of intraoperative onset new neurologic deficit was 0.4%. Significant changes in EEG and/or SSEPs occurred in 5.4% of the cases. Of the cases with IONM alerts, 78.5% returned to baseline with a surgical or hemodynamic intervention. From the cases with unresolved IONM alerts, 33.3% woke up with a new neurological deficit. The overall sensitivity and specificity for IONM was 100% and 99.2%, respectively. The positive predictive value was 33.3% and the negative predictive value was 100%.
Conclusions IONM during TCAR offers high sensitivity and specificity in predicting postoperative outcome. Patients with resolved IONM alerts had immediate neurological outcomes that were comparable to those who had no IONM alerts.
- Stent
- EEG
- CT Angiography
- Stroke
- Evoked Potentials, Somatosensory
Data availability statement
Data are available upon reasonable request.
Statistics from Altmetric.com
Data availability statement
Data are available upon reasonable request.
Footnotes
Contributors All coauthors read and reviewed the manuscripts and agree with the publication. They all contributed to the study being published. Authors’ contributions: Guarantor: CD and BC. Concept design: BC, DN. Drafting manuscript: CD, BC, NS. Data acquisition: CD, DN, BC. Revision, editing, approval of final draft: CD, DN, NS, CM, BC. Data analysis: CD.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests The authors CD, DN and BC are employees of Nuvasive/Globus Medical and CM is a consultant of Penumbra and Silk Road Medical.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.