Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
J Clin Neurophysiol. 2012 Oct;29(5):462-7. doi: 10.1097/WNP.0b013e31826bde88.
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.
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.
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.
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.
脑电图（EEG）可检测颈动脉内膜切除术（CEA）期间的夹闭引起的脑缺血，从而影响管理并最大限度地降低围手术期中风的风险。我们假设年龄、术前神经症状、对侧颈动脉≥70%和双侧椎动脉狭窄会增加夹闭引起的 EEG 变化的可能性，而单侧颈动脉狭窄≥70%则不会。
这是一项观察性队列研究，共纳入 299 例于 2009 年在一家大型城市学术医疗中心接受 CEA 并进行脑电图监测的患者。采用单变量和多变量逻辑回归进行分析。
同侧颈动脉狭窄≥70%降低了夹闭引起的神经生理功能障碍的可能性（比值比[OR] = 0.43，95%置信区间[CI] [0.18, 0.99]，P = 0.04），调整症状状态、对侧颈动脉或椎动脉狭窄程度以及年龄后。术前神经症状、对侧颈动脉狭窄≥70%和双侧颅外椎动脉狭窄独立增加了这些可能性（OR 2.62，95% CI [1.32, 5.18]，P = 0.005；OR 2.84，95% CI [1.27, 6.34]，P = 0.01；OR 3.58，95% CI [1.02, 12.53]，P = 0.04），调整其他因素后。年龄≥70 岁没有显著影响。
术前神经症状、对侧颈动脉狭窄≥70%和双侧椎动脉狭窄增加了术中脑电图检测到的夹闭性缺血的可能性，而同侧颈动脉狭窄≥70%则降低了这种可能性。
