University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Clin Neurophysiol. 2022 Sep;141:1-8. doi: 10.1016/j.clinph.2022.06.010. Epub 2022 Jun 24.
Transient ischemic attacks (TIA) after carotid endarterectomy (CEA) are not well-studied. We aimed to investigate the characteristics and the predictive role of intraoperative neurophysiological monitoring (IONM) in TIA post-CEA.
Patients who underwent CEA utilizing IONM from 2009-2020 were included. Analyses included TIA incidence, sensitivity, specificity, and predictive values of IONM, risk factor regression analyses, and mortality Kaplan Meier plots.
Out of 2232 patients, 46 experienced TIA, 14 of which were within 24 hours of CEA (p < 0.01). Nine of these patients displayed significant IONM changes during CEA. The odds of TIA increased with somatosensory evoked potential (SSEP) changes (Odds Ratio (OR): 2.48 95% Confidence Interval (CI): 1.14-5.4), electroencephalogram (EEG) changes (OR: 2.65 95% CI: 1.22-5.77), and combined SSEP/EEG changes (OR: 2.98 95% CI: 1.17-7.55). Patients with TIA were less likely to be alive after an average of 4.3 years (OR: 0.5 95% CI: 0.26-0.96).
The odds a patient will have TIA post-CEA are greater in patients with IONM changes. This risk is inversely related to the time post-CEA.
Changes in IONM during CEA predict postoperative TIA. Post-CEA TIA may increase long-term mortality, thus further research is needed to better elucidate clinical implications of postoperative TIA.
颈动脉内膜切除术（CEA）后的短暂性脑缺血发作（TIA）研究较少。本研究旨在探讨术中神经生理监测（IONM）在 CEA 后 TIA 中的特征和预测作用。
纳入 2009 年至 2020 年期间接受 IONM 指导下 CEA 的患者。分析包括 TIA 的发生率、IONM 的灵敏度、特异性和预测值、危险因素回归分析以及死亡率 Kaplan-Meier 图。
2232 例患者中，46 例发生 TIA，其中 14 例发生在 CEA 后 24 小时内（p<0.01）。这 9 例患者在 CEA 过程中 IONM 发生显著变化。体感诱发电位（SSEP）改变（优势比（OR）：2.48，95%置信区间（CI）：1.14-5.4）、脑电图（EEG）改变（OR：2.65，95%CI：1.22-5.77）和 SSEP/EEG 联合改变（OR：2.98，95%CI：1.17-7.55）的患者 TIA 发生率增加。平均随访 4.3 年后，TIA 患者的生存率较低（OR：0.5，95%CI：0.26-0.96）。
IONM 改变的患者 CEA 后发生 TIA 的可能性更大。这种风险与 CEA 后时间呈反比。
CEA 期间 IONM 的变化可预测术后 TIA。CEA 后 TIA 可能增加长期死亡率，因此需要进一步研究以更好地阐明术后 TIA 的临床意义。
