Jahangiri Faisal R, Liang Marie, Huckabey Misty, Baloney Naomi, Sharifi Sarah
Neurophysiology, Global Innervation LLC, Dallas, USA.
Neurology, AINeuroCare Academy, Dallas, USA.
Cureus. 2022 Jul 4;14(7):e26556. doi: 10.7759/cureus.26556. eCollection 2022 Jul.
Patients with untreated carotid artery stenosis remain at high risk for stroke. Carotid endarterectomy (CEA) is a surgical procedure for the treatment of symptomatic and severe asymptomatic carotid stenosis. A small percentage of patients who do not have good collateral circulation are at high risk of cerebral ischemia during the cross-clamping of the carotid artery. Aspects of CEA, such as cross-clamping and routine shunting, can also carry the risk of perioperative stroke through dislodgement of emboli causing thrombosis, therefore, selective shunting is highly recommended during the CEA procedure. A multimodality approach of intraoperative neurophysiological monitoring (IONM) techniques such as somatosensory evoked potential (SSEP) and electroencephalography (EEG) can be used to monitor cerebral perfusion throughout the duration of the surgery and to predict the need for a selective shunt after cross-clamping. Additional use of transcranial Doppler (TCD) in the multimodality approach can aid in visualizing the cerebral blood flow and detecting any microemboli that may also cause a stroke. A multimodality IONM approach has been reported as more sensitive and specific for predicting and minimizing any postoperative neurological deficits.
未经治疗的颈动脉狭窄患者仍然面临着较高的中风风险。颈动脉内膜切除术（CEA）是一种用于治疗有症状的严重无症状性颈动脉狭窄的外科手术。一小部分侧支循环不佳的患者在颈动脉交叉钳夹期间有发生脑缺血的高风险。CEA的一些操作，如交叉钳夹和常规分流，也可能因栓子脱落导致血栓形成而带来围手术期中风的风险，因此，在CEA手术过程中强烈推荐选择性分流。术中神经生理监测（IONM）技术的多模态方法，如体感诱发电位（SSEP）和脑电图（EEG），可用于在整个手术过程中监测脑灌注，并预测交叉钳夹后选择性分流的需求。在多模态方法中额外使用经颅多普勒（TCD）有助于观察脑血流并检测任何可能也导致中风的微栓子。据报道，多模态IONM方法在预测和最小化任何术后神经功能缺损方面更敏感、更具特异性。
