title: Intraoperative monitoring of carotid endarterectomy by transcranial motor evoked potential: a multicenter study of 600 patients.
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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  TcMEPs seem to improve postoperative outcome, especially in case of a timely correction of cerebral ischemia.
authors.affiliation: Division of Neuroanesthesia and Intraoperative Neuromonitoring, Department of Anesthesiology, Intensive Care and Pain Therapy, Klinikum St. Georg gGmbH, Leipzig, Germany. mmalcharek@me.com
authors.forename: M J
authors.initials: MJ
authors.lastname: Malcharek
authors.forename: S
authors.initials: S
authors.lastname: Ulkatan
authors.forename: V
authors.initials: V
authors.lastname: Marinò
authors.forename: M
authors.initials: M
authors.lastname: Geyer
authors.forename: E
authors.initials: E
authors.lastname: Lladó-Carbó
authors.forename: G
authors.initials: G
authors.lastname: Perez-Fajardo
authors.forename: B
authors.initials: B
authors.lastname: Arranz-Arranz
authors.forename: J
authors.initials: J
authors.lastname: Climent
authors.forename: F
authors.initials: F
authors.lastname: Aloj
authors.forename: E
authors.initials: E
authors.lastname: Franco
authors.forename: L
authors.initials: L
authors.lastname: Chiacchiari
authors.forename: A
authors.initials: A
authors.lastname: Kulpok
authors.forename: A
authors.initials: A
authors.lastname: Sablotzki
authors.forename: G
authors.initials: G
authors.lastname: Hennig
authors.forename: V
authors.initials: V
authors.lastname: Deletis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods; D002545:Brain Ischemia / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000503:physiopathology; D016894:Endarterectomy, Carotid / Q000379:methods; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D012189:Retrospective Studies