Cardiovascular-related mortality after intraoperative neurophysiologic monitoring changes during carotid endarterectomy. (July 2022)

• Record Type: Journal Article
• Authors: Paras, Stephanie; Mina, Amir; Crammond, Donald J.; Visweswaran, Shyam; Anetakis, Katherine M.; Balzer, Jeffrey R.; Shandal, Varun; Thirumala, Parthasarathy D.
• Is Part Of: Clinical neurophysiology. Volume 139(2022)
• Page Start: 43
• Page End: 48
• Publication Date: 2022-07
• Subjects: Carotid endarterectomy -- Intraoperative monitoring -- Mortality -- Stroke; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2022.04.005
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Carotid endarterectomy patients with intraoperative neurophysiologic monitoring changes had a doubled rate of long-term cardiovascular-related mortality. Patients with perioperative stroke showed a four times higher rate of long-term cardiovascular-related mortality. Intraoperative neurophysiologic monitoring changes are valuable in predicting long-term cardiovascular-related adverse outcomes. Abstract: Objective: We examined significant intraoperative neurophysiologic monitoring (IONM) changes and perioperative stroke as independent risk factors of long-term cardiovascular-related mortality in patients who have undergone carotid endarterectomy (CEA). Methods: Records of patients who underwent CEA with IONM at the University of Pittsburgh Medical Center between January 1, 2009 and December 31, 2019 were analyzed retrospectively. Cardiovascular-related mortality was compared between the significant IONM change group and no IONM change group and between the perioperative stroke group and no perioperative stroke group. Results: Our final cohort consisted of 2, 090 patients. Patients with significant IONM changes showed nearly twice the rate of cardiovascular-related mortality up to 10 years post-CEA (hazard ratio (HR) = 1.98; 95% confidence interval (CI) [1.20 – 3.26]). Patients with perioperative stroke were four times more likely than patients without perioperative stroke to experience cardiovascular-related mortality (HR = 4.09; 95% CI [2.13 – 7.86]). Conclusions: Among CEA patients who underwent CEA and who experienced significant IONM changes or perioperative stroke, we observed long-term increased and sustained risk of cardiovascular-related mortality. Significance: Significant IONM changes are valuable in predicting the risk of long-term outcomes following CEA.