Diagnostic Value of Somatosensory Evoked Potential Changes During Carotid Endarterectomy for 30-Day Perioperative Stroke

Publication date: Available online 14 June 2018
Source:Clinical Neurophysiology
Author(s): Rajiv P. Reddy, Indraneel S. Brahme, Tejas Karnati, Jeffrey Balzer, Donald J. Crammond, Katherine Anetakis, Parthasarathy D. Thirumala
ObjectivesSomatosensory evoked potentials (SSEPs) have proven useful as an intraoperative modality to predict perioperative stroke during carotid endarterectomy (CEA). However, the predictive value of SSEPs for predicting stroke 30 days postoperatively remains unclear. The primary objective is to evaluate the efficacy of intraoperative SSEP change in predicting the risk of stroke in the postoperative period beyond 24 hours but within 30 days. Our secondary aim is to evaluate the predictive value of each subcategory of SSEP change.MethodsWe performed a meta-analysis of 25 prospective/retrospective studies from PubMed, Web of Science, and Embase regarding SSEP monitoring for postoperative outcomes in symptomatic and asymptomatic CEA patients.ResultsA 8307-patient cohort composed the total sample population, of which 54.17% had symptomatic CS. For SSEP change and stroke greater than 24 hours but within 30 days, the diagnostic odds ratio was 8.68. The diagnostic odds ratio was 3.88 for transient SSEP change and stroke; 49.29 for persistent SSEP change and stroke; 36.45 for transient SSEP loss and stroke; and 281.35 for persistent SSEP loss and stroke.ConclusionsPatients with SSEP changes are at increased risk of perioperative stroke within the entire 30-day period. There is a noticeable step-wise increase in the predicted risk of stroke with the severity of SSEP changes.SignificanceSSEP changes can serve as a predictor for 30-day perioperative stroke during CEA.



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