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Carotid Endarterectomy Surgeries: A Multimodality Intraoperative Neurophysiological Monitoring Approach

Patients with untreated carotid artery stenosis remain at high risk for stroke. Carotid endarterectomy (CEA) is a surgical procedure for the treatment of symptomatic and severe asymptomatic carotid stenosis. A small percentage of patients who do not have good collateral circulation are at high risk...

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Autores principales: Jahangiri, Faisal R, Liang, Marie, Huckabey, Misty, Baloney, Naomi, Sharifi, Sarah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9348437/
https://www.ncbi.nlm.nih.gov/pubmed/35936121
http://dx.doi.org/10.7759/cureus.26556
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author Jahangiri, Faisal R
Liang, Marie
Huckabey, Misty
Baloney, Naomi
Sharifi, Sarah
author_facet Jahangiri, Faisal R
Liang, Marie
Huckabey, Misty
Baloney, Naomi
Sharifi, Sarah
author_sort Jahangiri, Faisal R
collection PubMed
description Patients with untreated carotid artery stenosis remain at high risk for stroke. Carotid endarterectomy (CEA) is a surgical procedure for the treatment of symptomatic and severe asymptomatic carotid stenosis. A small percentage of patients who do not have good collateral circulation are at high risk of cerebral ischemia during the cross-clamping of the carotid artery. Aspects of CEA, such as cross-clamping and routine shunting, can also carry the risk of perioperative stroke through dislodgement of emboli causing thrombosis, therefore, selective shunting is highly recommended during the CEA procedure. A multimodality approach of intraoperative neurophysiological monitoring (IONM) techniques such as somatosensory evoked potential (SSEP) and electroencephalography (EEG) can be used to monitor cerebral perfusion throughout the duration of the surgery and to predict the need for a selective shunt after cross-clamping. Additional use of transcranial Doppler (TCD) in the multimodality approach can aid in visualizing the cerebral blood flow and detecting any microemboli that may also cause a stroke. A multimodality IONM approach has been reported as more sensitive and specific for predicting and minimizing any postoperative neurological deficits.
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spelling pubmed-93484372022-08-04 Carotid Endarterectomy Surgeries: A Multimodality Intraoperative Neurophysiological Monitoring Approach Jahangiri, Faisal R Liang, Marie Huckabey, Misty Baloney, Naomi Sharifi, Sarah Cureus Cardiac/Thoracic/Vascular Surgery Patients with untreated carotid artery stenosis remain at high risk for stroke. Carotid endarterectomy (CEA) is a surgical procedure for the treatment of symptomatic and severe asymptomatic carotid stenosis. A small percentage of patients who do not have good collateral circulation are at high risk of cerebral ischemia during the cross-clamping of the carotid artery. Aspects of CEA, such as cross-clamping and routine shunting, can also carry the risk of perioperative stroke through dislodgement of emboli causing thrombosis, therefore, selective shunting is highly recommended during the CEA procedure. A multimodality approach of intraoperative neurophysiological monitoring (IONM) techniques such as somatosensory evoked potential (SSEP) and electroencephalography (EEG) can be used to monitor cerebral perfusion throughout the duration of the surgery and to predict the need for a selective shunt after cross-clamping. Additional use of transcranial Doppler (TCD) in the multimodality approach can aid in visualizing the cerebral blood flow and detecting any microemboli that may also cause a stroke. A multimodality IONM approach has been reported as more sensitive and specific for predicting and minimizing any postoperative neurological deficits. Cureus 2022-07-04 /pmc/articles/PMC9348437/ /pubmed/35936121 http://dx.doi.org/10.7759/cureus.26556 Text en Copyright © 2022, Jahangiri et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Cardiac/Thoracic/Vascular Surgery
Jahangiri, Faisal R
Liang, Marie
Huckabey, Misty
Baloney, Naomi
Sharifi, Sarah
Carotid Endarterectomy Surgeries: A Multimodality Intraoperative Neurophysiological Monitoring Approach
title Carotid Endarterectomy Surgeries: A Multimodality Intraoperative Neurophysiological Monitoring Approach
title_full Carotid Endarterectomy Surgeries: A Multimodality Intraoperative Neurophysiological Monitoring Approach
title_fullStr Carotid Endarterectomy Surgeries: A Multimodality Intraoperative Neurophysiological Monitoring Approach
title_full_unstemmed Carotid Endarterectomy Surgeries: A Multimodality Intraoperative Neurophysiological Monitoring Approach
title_short Carotid Endarterectomy Surgeries: A Multimodality Intraoperative Neurophysiological Monitoring Approach
title_sort carotid endarterectomy surgeries: a multimodality intraoperative neurophysiological monitoring approach
topic Cardiac/Thoracic/Vascular Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9348437/
https://www.ncbi.nlm.nih.gov/pubmed/35936121
http://dx.doi.org/10.7759/cureus.26556
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