Intraoperative monitoring of carotid endarterectomy by transcranial motor evoked potential: A multicenter study of 600 patients

M. J. Malcharek, S. Ulkatan, V. Marinò, M. Geyer, E. LLadó-Carbó, G. Perez-Fajardo, B. Arranz-Arranz, J. Climent, F. Aloj, E. Franco, L. Chiacchiari, A. Kulpok, A. Sablotzki, G. Hennig, V. Deletis

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: This study was to investigate the utility of motor evoked potential monitoring elicited by transcranial electrical stimulation (tcMEP) during CEA in addition to the established median nerve somatosensory evoked potentials (mSSEPs). Methods: We retrospectively reviewed data from 600 patients undergoing CEA under general anesthesia with monitoring of mSSEPs and tcMEPs in a multicenter study. MSSEP and tcMEP parameters were recorded during internal carotid artery (ICA) cross clamping and compared with the postoperative motor outcome, demographic and patient history data. Results: The intraoperative monitoring of tcMEPs was successful in 594 of the patients (99%) and selective shunt was performed in 29 of them (4.83%). Nine of the patients showed a transient contralateral loss of tcMEPs, without changes in mSSEPs and required intervention (1.5% "false-negative"). Three of them showed postoperative motor deficits. The time period from tcMEP loss to intervention was significantly longer (p= 0.01) in this group compared to the patients without postoperative motor deficit. Conclusion: TcMEPs during CEA may be an adjunct to mSSEP monitoring to avoid "false-negative" mSSEP results, as mSSEPs seem to lack specificity for detecting isolated ischemia of corticospinal pathway. Significance: TcMEPs seem to improve postoperative outcome, especially in case of a timely correction of cerebral ischemia.

Original languageEnglish
Pages (from-to)1025-1030
Number of pages6
JournalClinical Neurophysiology
Volume124
Issue number5
DOIs
Publication statusPublished - May 2013

Keywords

  • Carotid endarterectomy
  • Intraoperative neurophysiological monitoring
  • Motor evoked potentials
  • Postoperative stroke
  • Somatosensory evoked potentials
  • Symptomatic carotid stenosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Physiology (medical)
  • Sensory Systems

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