EEG monitoring of carotid endarterectomy with routine patch-graft angioplasty: an experience in a large series.
Four hundred and thirty-nine carotid endarterectomies (CEAs) with routine use of patchgraft angioplasty were performed in 375 patients; the indwelling shunt was used only in patients showing clamp-related EEG abnormalities. Five patients showed EEG abnormalities just after head positioning, which reversed after removal of head hyperextension; three cases suffered EEG flattening due to severe bradycardia or cardiac arrest before carotid clamping, which promptly reversed after treatment. Clamp-related EEG abnormalities appeared in 106 operations (24.2%) and all reversed after the insertion of the indwelling shunt; patients with occlusion of the contralateral internal carotid artery showed a 68.8% rate of EEG clamp-related changes. The short term follow-up (one month after the operation) showed six minor strokes with complete recovery (1.37%), one intraoperative stroke (0.23%), three delayed major strokes (0.69%) and three neurological deaths (0.69%). The long-term follow-up over an average of 42 months showed a 3.7% rate of relevant neurological complications (ie permanent deficits + death) and a 3.16% rate significant restenosis or occlusion of the operated carotid artery. Our results show that the routine use of EEG monitoring and patch-graft angioplasty allow to perform CEAs with a very high degree of safety, improving the clinical course of the disease.
Facco
E
E
Department of Anesthesiology and Intensive Care, University of Padua, Italy.
Deriu
G P
GP
Donà
B
B
Ballotta
E
E
Munari
M
M
Grego
F
F
Behr
A U
AU
Baratto
F
F
Franceschi
L
L
Giron
G P
GP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control; D004569:Electroencephalography; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D016343:Monitoring, Intraoperative