title: Diagnostic accuracy of somatosensory evoked potential and electroencephalography during carotid endarterectomy.
abstract: OBJECTIVE
  Perioperative stroke risk following carotid endarterectomy (CEA) is reported to be approximately 2-3%. The diagnostic accuracies of intraoperative EEG and SSEP monitoring during CEA have been studied separately. However, to date, the effectiveness of simultaneous EEG and SSEP monitoring during CEA has only been evaluated in small study populations. This study examined the diagnostic accuracy of combined EEG and SSEP monitoring in a large (N = 1165) patient population.
  
  
  METHODS
  This study included 1165 patients who underwent CEA from 2000 to 2012 at the University of Pittsburgh Medical Center. The sensitivities, specificities, and diagnostic odds ratio of EEG and SSEP monitoring methods were examined separately and together. Receiver operating characteristic curves were plotted to assess sensitivity and specificity of single and combined Intraoperative monitoring (IONM) methods.
  
  
  RESULTS
  Maximum sensitivity was obtained with multimodality monitoring with an IONM change in either EEG or SSEP of 50.00 (95% CI, 30.66-69.34). The specificity of simultaneous EEG and SSEP changes was 93.95 (95% CI, 92.28-95.35%). Maximum area under ROC curve obtained for IONM change in either EEG or SSEP was 0.660 (95% CI, 0.547-0.773, p-value 0.004).
  
  
  CONCLUSIONS
  The diagnostic accuracy of multimodality IONM during CEA is higher than an approach using single modality IONM. Simultaneous EEG and SSEP monitoring improves the likelihood of detecting periprocedural strokes after CEA. Neuro protective therapies to prevent periprocedural strokes can be based on changes in SSEP and EEG during CEA.
authors.affiliation: a Department of Neurological Surgery , Universityof Pittsburgh Medical Center , Pittsburgh , PA , USA.|b Department of Neurology , University of Pittsburgh Medical Center , Pittsburgh , PA , USA.
authors.forename: Parthasarathy D
authors.initials: PD
authors.lastname: Thirumala
authors.affiliation: a Department of Neurological Surgery , Universityof Pittsburgh Medical Center , Pittsburgh , PA , USA.
authors.forename: Piruthiviraj
authors.initials: P
authors.lastname: Natarajan
authors.affiliation: a Department of Neurological Surgery , Universityof Pittsburgh Medical Center , Pittsburgh , PA , USA.
authors.forename: Karthy
authors.initials: K
authors.lastname: Thiagarajan
authors.affiliation: a Department of Neurological Surgery , Universityof Pittsburgh Medical Center , Pittsburgh , PA , USA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Crammond
authors.affiliation: a Department of Neurological Surgery , Universityof Pittsburgh Medical Center , Pittsburgh , PA , USA.
authors.forename: Miguel E
authors.initials: ME
authors.lastname: Habeych
authors.affiliation: c Division of Vascular Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA.
authors.forename: Rabih A
authors.initials: RA
authors.lastname: Chaer
authors.affiliation: c Division of Vascular Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA.
authors.forename: Efthymios D
authors.initials: ED
authors.lastname: Avgerinos
authors.affiliation: a Department of Neurological Surgery , Universityof Pittsburgh Medical Center , Pittsburgh , PA , USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Friedlander
authors.affiliation: a Department of Neurological Surgery , Universityof Pittsburgh Medical Center , Pittsburgh , PA , USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Balzer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000601:surgery; D004558:Electric Stimulation; D004569:Electroencephalography; D016894:Endarterectomy, Carotid; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010525:Peripheral Nerves / Q000503:physiopathology; D012372:ROC Curve; D012189:Retrospective Studies; D013057:Spectrum Analysis; D020521:Stroke / Q000517:prevention & control
keywords: Carotid endarterectomy; Carotid stenosis; EEG; Intraoperative neurophysiological monitoring; Somatosensory evoked potential; Stroke