Intraoperative neurophysiological monitoring during urgent surgical extracranial internal carotid artery recanalization. (June 2022)

• Record Type: Journal Article
• Authors: Ostrý, Svatopluk; Nevšímal, Milan; Reiser, Martin; Voldřich, Richard; Krtička, Ondřej; Kubále, Jiří; Nevšímalová, Miroslava; Fiedler, Jiří
• Is Part Of: Clinical neurophysiology. Volume 138(2022)
• Page Start: 221
• Page End: 230
• Publication Date: 2022-06
• Subjects: Somatosensory evoked potentials -- Intraoperative monitoring -- Selective shunting -- Ischemic stroke -- Urgent recanalization; AComA anterior communicant artery -- AIM acute myocardial infarction -- BSL baseline -- CEA carotid endarterectomy -- CCA common carotid artery -- CCA-CC common carotid artery cross-clamp -- CHD congestive heart disease -- CI confidence interval -- CT computed tomography -- CTA computed tomography angiography -- CTP computed tomography perfusion -- DNT door-to-needle time -- DTF door-to-flow time -- DWI diffusion-weighted image -- eICA extracranial internal carotid artery -- ECA external carotid artery -- EC-IC extracranial – intracranial bypass -- FLAIR fluid-attenuated inversion recovery image -- ICA internal carotid artery -- ICH intracranial hemorrhage -- INR international ratio -- IOM intraoperative monitoring -- IQR interquartile ratio -- IVT intravenous thrombolysis -- IHD ischemic heart disease -- LAO large artery occlusion -- LC leptomeningeal collaterals -- MAP mean arterial pressure -- min minute -- MRI magnetic resonance imaging -- MRC Medical Research Council score -- MRC-UE Medical Research Council score – upper extremity -- MRC-LE Medical Research Council score – lower extremity -- mRS modified Rankin scale -- MT mechanical thrombectomy -- NCCT nonenhanced cerebral computed tomography -- NIHSS National Institute of Health Stroke Scale -- NPV negative predictive value -- NS nonsignificant -- OA ophthalmic artery -- OPD obstructive pulmonary disease -- OTF onset-to-flow time -- PAD peripheral artery disease -- PComm posterior communicant artery -- PPV positive predictive value -- rCBF regional cerebral blood flow -- SEP somatosensory evoked potential -- SEP-amp somatosensory evoked potentials amplitude absolute value on the symptomatic side -- SEP-ratio somatosensory evoked potentials side-to-side amplitude ratio (symptomatic/asymptomatic) -- SEP-CC somatosensory evoked potentials amplitude after cross clamp on the symptomatic side -- SD standard deviation -- sICH symptomatic intracranial hemorrhage -- SIE stroke in evolution -- TIA transient ischemic attack -- TICI treatment in cerebral ischemia score -- WUS wake-up stroke -- µV microvolt; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2022.01.135
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Intraoperative ischemia during urgent internal carotid artery recanalization is preventable by selective shunting. Selective shunting based on intraoperative somatosensory evoked potentials may prevent intraoperative ischemia development. Intraoperative monitoring may contribute to improving of clinical outcome after urgent internal carotid artery recanalization. Abstract: Objective: The clinical outcome of surgical extracranial internal carotid artery (eICA) recanalization may be adversely affected by intraoperative ischemia. Median nerve somatosensory evoked potential (SEP) amplitude correlates well with cerebral blood flow. Our study presents the value of intraoperative SEP and selective shunting in the prevention of intraoperative ischemia development during urgent eICA recanalization. Methods: Prospective recruitment of patients with acute unilateral eICA occlusion. All underwent surgical recanalization with intraoperative monitoring of scalp median SEPs. Preoperative clinical findings, cerebral collaterals, and 3 month functional outcome were evaluated. Results: The cohort consisted of 33 patients. Intraoperative SEP amplitude decreased significantly in 6 (18.2%). An intraluminal shunt was inserted twice (6.1%), surgical complications occurred in 6 (18.2%), intracerebral hemorrhage was not found. Favorable outcome 3 months after surgery according to the modified Rankin scale (mRS 0–2) was achieved in 28 (84.8%), 3 patients died (9.1%). Conclusions: Intraoperative SEP during urgent eICA recanalization seems to be beneficial. Thanks to the effective measure based on the intraoperative SEP changes, the clinical outcome in four (12.1%) could be positively affected. Significance: The results suggest that selective shunting based on intraoperative median SEPs may prevent intraoperative ischemia and may improve overall outcome of urgent eICA recanalization.