Intraoperative Neurophysiology and Transcranial Doppler for Detection of Cerebral Ischemia and Hyperperfusion During Carotid Endarterectomy
| Autor: | Robert N. Holdefer, Qing Gai, Wengao Zhang, Yansheng Zhang, Qin Liu, LanJun Guo, Jinfeng Wang |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Intraoperative Neurophysiological Monitoring Ultrasonography Doppler Transcranial medicine.medical_treatment Ischemia Carotid endarterectomy Brain Ischemia Evoked Potentials Somatosensory Internal medicine Humans Medicine Carotid Stenosis Evoked potential Stroke Aged Retrospective Studies Endarterectomy Carotid Muscle Weakness business.industry Electroencephalography Blood flow Middle Aged Evoked Potentials Motor medicine.disease Transcranial Doppler Treatment Outcome Somatosensory evoked potential Cerebrovascular Circulation cardiovascular system Cardiology Female Surgery Neurology (clinical) business Intraoperative neurophysiological monitoring |
| Zdroj: | World Neurosurgery. 154:e245-e253 |
| ISSN: | 1878-8750 |
| Popis: | To evaluate and compare efficacy of intraoperative neurophysiological monitoring (IONM) and intraoperative transcranial Doppler (TCD) techniques for identification of hypoperfusion during carotid artery clamp and hyperperfusion after release of occlusion during carotid endarterectomy.This was a retrospective, consecutive case series of 152 patients undergoing carotid endarterectomy between June 2018 and March 2020. Somatosensory evoked potentials, motor evoked potentials, electroencephalogram, and TCD were obtained.Three patient cohorts were observed after clamping the carotid artery: A, in 132 of 152 patients (87%), TCD blood flow velocity decreased by50% and there were no changes in IONM; B, in 5 of 152 (3%) patients, TCD blood flow rate was reduced 50%-100% with no changes in IONM; C, in 15 patients (10%), blood flow velocity was reduced by 50%-100% and all IONM modalities met warning criteria. With increased blood pressure, IONM and blood flow velocities improved to less than warning criteria in 8 of 15 patients. In 6 of the 7 remaining patients, IONM modalities recovered to baseline immediately after clamps were removed from the carotid artery. The 1 patient with persistent motor evoked potential deterioration experienced postoperative proximal muscle weakness, which recovered 48 hours later. In 22 patients, TCD detected hyperperfusion at the moment of clamp release.TCD blood flow velocity is correlated with motor evoked potential and somatosensory evoked potential amplitude changes after clamping. After declamping, TCD can detect hyperperfusion and help regulate blood pressure to prevent hyperperfusion. |
| Databáze: | OpenAIRE |
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