Document Detail

Predictors of clamp-induced electroencephalographic changes during carotid endarterectomies.
MedLine Citation:
PMID:  23027104     Owner:  NLM     Status:  In-Data-Review    
OBJECTIVE: : Electroencephalograms (EEGs) detect clamp-induced cerebral ischemia during carotid endarterectomy (CEA) and thus impact management and minimize the risk of perioperative stroke. We hypothesized that age, preoperative neurologic symptoms, ≥70% contralateral carotid and bilateral vertebral stenosis increase the probability of clamp-induced EEG changes, whereas ≥70% unilateral carotid stenosis does not.
METHODS: : This is an observational cohort study of 299 patients who underwent CEA with EEG monitoring at a single large urban academic medical center in 2009. Univariate and multivariate logistic regression were used.
RESULTS: : Seventy percent or greater ipsilateral carotid stenosis decreases the odds of clamp-induced neurophysiologic dysfunction (odds ratio [OR] = 0.43, 95% confidence interval [CI] [0.18, 0.99], P = 0.04) after adjustment for symptomatic status, degree contralateral carotid or vertebral stenosis, and age. Preoperative neurologic symptoms, ≥70% contralateral carotid stenosis, and bilateral extracranial vertebral stenosis independently increase these odds (OR 2.62, 95% CI [1.32, 5.18], P = 0.005; OR 2.84, 95% CI [1.27, 6.34], P = 0.01; and OR 3.58, 95% CI [1.02, 12.53], P = 0.04, respectively), after adjustment for the other factors. Age ≥70 years has no significant impact.
CONCLUSIONS: : Preoperative neurologic symptoms, ≥70% contralateral carotid, and bilateral vertebral stenosis increase the probability of clamp-induced ischemia as detected by intraoperative EEG, while ≥70% ipsilateral carotid stenosis decreases it.
Mirela V Simon; Keith H Chiappa; Ronan D Kilbride; Guy A Rordorf; Richard P Cambria; Christopher S Ogilvy; Christopher J Kwolek; Glenn M Lamuraglia; Mark F Conrad; Karen L Furie
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society     Volume:  29     ISSN:  1537-1603     ISO Abbreviation:  J Clin Neurophysiol     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-02     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8506708     Medline TA:  J Clin Neurophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  462-7     Citation Subset:  IM    
*Departments of Neurology †Vascular Surgery ‡Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Maryland, U.S.A.
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