Multimodal Neurophysiological Monitoring Reduces Shunt Incidence during Carotid Endarterectomy.

Background: The use of shunt during carotid surgery is controversial. Different experiences are found in literature with transcranial Doppler (TCD), electroencephalogram (EEG), stump pressure (SP), and somatosensorial evoked potentials (SSEP).

Methods: We realized a retrospective analysis of patients treated with carotid endarterectomy in our unit in the last 2 years. We use several cerebral monitoring: until 2017 we preferred SP + TCD, and, if not available, EEG. Since 2017 we introduced EEG with SSEP, always in association with SP. We analyzed those 2 groups of patients: before and after introduction of EEG with SSEP.

Results: From January 2016 to December 2018 we performed 156 carotid revascularizations. In the first group of 93 patients treated under combined SP + TCD (or EEG), we observed 1 stroke (1.1%) and 2 transient ischemic attacks (TIAs) (2.1%); we selectively used a shunt in 21 cases (22.5%). In the second group, 63 patients had an SP + EEG with SSEP monitoring; we observed 1 stroke (1.5%) and 2 TIAs (3.1%), a shunt was necessary in 12 cases (12.9%).

Conclusions: In our experience, EEG with SSEP represents an effective parameter to indicate shunt positioning, as we were able to reduce its use, with the same incidence of stroke and TIA.