Monitoring of somatosensory evoked potentials during carotid endarterectomy: Relationship with different haemodynamic parameters and clinical outcome

Shunting during carotid endarterectomy

“…Proponents of SSEP agree on its feasibility, safety, [46][47][48][49] and high reliability in detecting early neurological changes. Others have claimed that utility of SSEP is not well characterized and is less accurate than other modalities.…”

“…The optimal method for evaluating cerebral perfusion during CEA and to determine the need for selective shunting is also controversial. In patients undergoing CEA under general anesthesia, several investigators prefer electroencephalogram (EEG) monitoring, [22][23][24][25][26][27][28][29] while others prefer transcranial Doppler (TCD), [30][31][32][33][34][35] carotid stump pressure (SP) measurements, 14,[36][37][38][39][40][41][42][43][44][45] somatosensory evoked potential (SSEP), [46][47][48][49][50][51][52][53][54][55] or cerebral oximetry monitoring 56,57 to determine the need for shunting. Meanwhile, for patients undergoing CEA with regional anesthesia, selective shunting can be based on alterations in the neurological examination that develop after carotid clamping.…”

Alterationen der somatosensorisch evozierten Potentiale (SEP) bei 482 Karotisrekonstruktionen

“…Ein konsequentes selektives Shunting verhindert überflüssige und komplikationsträchtige intravasale Manipulationen und ist unserer Auffassung nach ein wichtiger Beitrag zur Risikominimierung. Bei strenger Indikationsstellung sind Shuntraten von etwa 5-10% zu erwarten [20,23]. Sicherheit und fehlender Zeitdruck dürften sich günstig auf die Qualität der CEA auswirken.…”