Predicting transient ischemic attack after carotid endarterectomy: The role of intraoperative neurophysiological monitoring. (September 2022)

• Record Type: Journal Article
• Authors: Moehl, Keelin; Shandal, Varun; Anetakis, Katherine; Paras, Stephanie; Mina, Amir; Crammond, Donald; Balzer, Jeffrey; Thirumala, Parthasarathy D.
• Is Part Of: Clinical neurophysiology. Volume 141(2022)
• Page Start: 1
• Page End: 8
• Publication Date: 2022-09
• Subjects: Transient ischemic attack -- Carotid endarterectomy -- Somatosensory evoked potentials -- Electroencephalography -- Intraoperative neurophysiological monitoring; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2022.06.010
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: After undergoing carotid endarterectomy (CEA), 2.1% of patients experienced a postoperative transient ischemic attack (TIA). The odds a patient will experience a TIA post-CEA are greater in patients with intraoperative electroencephalogram (EEG) and somatosensory evoked potential (SSEP) changes. Our study found the odds of mortality post-CEA significantly doubled in patients who experienced postoperative TIA. Abstract: Objective: Transient ischemic attacks (TIA) after carotid endarterectomy (CEA) are not well-studied. We aimed to investigate the characteristics and the predictive role of intraoperative neurophysiological monitoring (IONM) in TIA post-CEA. Methods: Patients who underwent CEA utilizing IONM from 2009-2020 were included. Analyses included TIA incidence, sensitivity, specificity, and predictive values of IONM, risk factor regression analyses, and mortality Kaplan Meier plots. Results: Out of 2232 patients, 46 experienced TIA, 14 of which were within 24 hours of CEA (p < 0.01). Nine of these patients displayed significant IONM changes during CEA. The odds of TIA increased with somatosensory evoked potential (SSEP) changes (Odds Ratio (OR): 2.48 95% Confidence Interval (CI): 1.14–5.4), electroencephalogram (EEG) changes (OR: 2.65 95% CI: 1.22–5.77), and combined SSEP/EEG changes (OR: 2.98 95% CI: 1.17–7.55). Patients with TIA were less likely to be alive after an average of 4.3 years (OR: 0.5 95% CI: 0.26–0.96). Conclusions: The odds a patient will have TIA post-CEA are greater in patients with IONM changes. This risk is inversely related to the time post-CEA. Significance: Changes in IONM during CEA predict postoperative TIA. Post-CEA TIA may increase long-term mortality, thus further research is needed to better elucidate clinical implications of postoperative TIA.