Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA.
Clin Neurophysiol. 2020 Jul;131(7):1508-1516. doi: 10.1016/j.clinph.2020.03.037. Epub 2020 Apr 23.
We assessed whether significant intraoperative electroencephalography (EEG) changes have predictive value for perioperative stroke within 30 days after carotid endarterectomy (CEA) procedures for carotid stenosis (CS) patients. We also assessed the diagnostic accuracy of various EEG changes in predicting perioperative stroke.
We searched databases for reports with outcomes of CS patients who underwent CEA with intraoperative EEG monitoring. We calculated the sensitivity, specificity, and diagnostic odds ratio (DOR) of EEG changes for predicting perioperative stroke. Sensitivity and specificity were presented with forest plots and a summary receiver operating characteristic (ROC) curve.
The meta-analysis included 10,672 patients. Intraoperative EEG changes predicted 30-day stroke with a sensitivity of 46% (95% CI, 38-54%) and specificity of 86% (95% CI, 83-88%). The estimated DOR was 5.79 (95% CI, 3.86-8.69). The estimated DOR for reversible and irreversible EEG changes were 8.25 (95% CI, 3.34-20.34) and 70.84 (95% CI, 36.01-139.37), respectively.
Intraoperative EEG changes have high specificity but modest sensitivity for predicting perioperative stroke following CEA. Patients with irreversible EEG changes are at high risk for perioperative stroke.
Intraoperative EEG changes can help surgeons predict the risk of perioperative stroke for CS patients following CEA.
我们评估了颈动脉内膜切除术（CEA）治疗颈动脉狭窄（CS）患者围手术期 30 天内，术中脑电图（EEG）显著变化是否对术后卒中具有预测价值。我们还评估了各种 EEG 变化预测围手术期卒中的诊断准确性。
我们在数据库中搜索了接受术中 EEG 监测的 CEA 治疗 CS 患者的结局报告。我们计算了 EEG 变化预测围手术期卒中的敏感性、特异性和诊断优势比（DOR）。采用森林图和汇总受试者工作特征（ROC）曲线呈现敏感性和特异性。
荟萃分析纳入了 10672 例患者。术中 EEG 变化预测 30 天卒中的敏感性为 46%（95%CI，38-54%），特异性为 86%（95%CI，83-88%）。估计的 DOR 为 5.79（95%CI，3.86-8.69）。可逆和不可逆 EEG 变化的估计 DOR 分别为 8.25（95%CI，3.34-20.34）和 70.84（95%CI，36.01-139.37）。
术中 EEG 变化对预测 CEA 后围手术期卒中具有高特异性，但敏感性中等。出现不可逆 EEG 变化的患者围手术期卒中风险较高。
术中 EEG 变化可帮助外科医生预测 CEA 治疗 CS 患者围手术期卒中的风险。
