Diagnostic value of somatosensory evoked potential changes during carotid endarterectomy for 30-day perioperative stroke. Issue 9 (September 2018)

• Record Type: Journal Article
• Authors: Reddy, Rajiv P.; Brahme, Indraneel S.; Karnati, Tejas; Balzer, Jeffrey R.; Crammond, Donald J.; Anetakis, Katherine M.; Thirumala, Parthasarathy D.
• Is Part Of: Clinical neurophysiology. Volume 129:Issue 9(2018:Sep.)
• Page Start: 1819
• Page End: 1831
• Publication Date: 2018-09
• Subjects: Somatosensory evoked potentials (SSEP) -- Carotid endarterectomy (CEA) -- Stroke -- Intraoperative neurophysiologic monitoring (IONM) -- Carotid stenosis (CS) -- Cerebrovascular perfusion; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2018.05.018
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Patients with SSEP changes during carotid endarterectomy (CEA) have 9 times higher stroke risk in the 30-day post-op period. Loss of SSEP during CEA generally indicates greater perioperative stroke risk than change in SSEP. Persistent SSEP change indicates greater perioperative stroke risk than a transient SSEP change. Abstract: Objectives: Somatosensory evoked potentials (SSEPs) have proven useful as an intraoperative modality to predict perioperative stroke during carotid endarterectomy (CEA). However, the predictive value of SSEPs for predicting stroke 30 days postoperatively remains unclear. The primary objective is to evaluate the efficacy of intraoperative SSEP change in predicting the risk of stroke in the postoperative period beyond 24 h but within 30 days. Our secondary aim is to evaluate the predictive value of each subcategory of SSEP change. Methods: We performed a meta-analysis of 25 prospective/retrospective studies from PubMed, Web of Science, and Embase regarding SSEP monitoring for postoperative outcomes in symptomatic and asymptomatic CEA patients. Results: A 8307-patient cohort composed the total sample population, of which 54.17% had symptomatic CS. For SSEP change and stroke greater than 24 h but within 30 days, the diagnostic odds ratio was 8.68. The diagnostic odds ratio was 3.88 for transient SSEP change and stroke; 49.29 for persistent SSEP change and stroke; 36.45 for transient SSEP loss and stroke; and 281.35 for persistent SSEP loss and stroke. Conclusions: Patients with SSEP changes are at increased risk of perioperative stroke within the entire 30-day period. There is a noticeable step-wise increase in the predicted risk of stroke with the severity of SSEP changes. Significance: SSEP changes can serve as a predictor for 30-day perioperative stroke during CEA.