Intraoperative Eeg Does Not Correlate With Neurologic Outcome In TCAR
Laura C. Lamb, MD, Parth Shah, MD, Thomas Divinagracia, MD, Akhilesh Jain, MD, James Gallagher, III, MD, Edward Gifford, MD.
Hartford Healthcare, Hartford, CT, USA.
About 14% of patients undergoing carotid endarterectomy (CEA) with continuous electroencephalographic (EEG) neuromonitoring require shunt placement due to EEG changes. Initial studies of transcarotid artery revascularization (TCAR) found only one patient with temporary EEG changes. We report our experience with intraoperative EEG monitoring during TCAR.
We conducted a retrospective review of patients from May 2017 to July 2019 who received TCAR at two urban hospitals within an integrated healthcare network. Data included demographic information, patient comorbidities, symptom status, prior carotid interventions, contralateral disease, intra-operative vital signs and EEG changes, and post-operative major adverse events (transient ischemic attack (TIA), stroke, myocardial infarction (MI), and death) both initially and at 30 days post-operatively. Based on the small sample size, univariate analysis was performed with Wilcoxon Rank Sum and Fisher’s Exact test for continuous and categorical variables, respectively.
Fifty-seven patients underwent TCAR. 74% of patients were male. Median age was 76 years (Interquartile range 70 - 81). Symptomatic patients accounted for 38% of the cohort. 93% of patients had general anesthesia, and overall 44 patients, or 77%, had continuous EEG monitoring. Six patients (14%) had EEG changes during TCAR. Changes resolved with pressure augmentation (1), low flow toggle (2), and unclamping after completing flow reversal (3). No patients with changes sustained post-operative complications. Patients with EEG changes were similar in their comorbidities, demographics, and indications for surgery to patients without EEG changes. Overall there was one post-operative TIA, one post-operative stroke, one myocardial infarction, and two post-operative deaths, for a 30-day stroke/death/MI rate of 9%.
In our study changes in continuous EEG were more frequent than previously reported. However, there was no correlation of EEG changes with pre-operative anatomy or symptom status or post-operative outcome. EEG monitoring during TCAR is transient, and does not correlate with post-operative events.
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