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Value of preoperative EEG for carotid endarterectomy.

Publication ,  Journal Article
Illig, KA; Burchfiel, JL; Ouriel, K; DeWeese, JA; Shortell, CK; Green, RM
Published in: Cardiovasc Surg
October 1998

PURPOSE: This study was designed to determine whether the preoperative, baseline electroencephalogram (EEG) can be used for intraoperative decision making during carotid endarterectomy, and to identify circumstances where the EEG can be eliminated. METHODS: The charts of all patients undergoing carotid endartectomy at the authors' institution from June 1991 to May 1995 were reviewed to identify those patients that had adequate pre- and intraoperative EEG monitoring. EEGs during 331 carotid endartectomies in 303 patients were coded without knowledge of outcome; primary and secondary endpoints were EEG changes with clamping and clinical outcome, respectively. RESULTS: The incidence of mortality and major neurological morbidity was 1.8%. Baseline-EEGs were abnormal in 105 patients (32%). Whereas baseline-EEG changes were highly predictive of EEG changes after anesthetic induction (P < .0001), they were not predictive of EEG changes with clamping or of clinical outcome. Prior stroke (CVA) predicted abnormal baseline-EEGs (P < .0001) and abnormal post-anesthetic EEGs (P < .0001) but did not predict changes with clamping or perioperative CVA. EEG changes with clamping occurred during 18% of operations; such changes were predicted only by contralateral occlusion (P < .0016) and EEG changes during a prior contralateral carotid endartectomy (P < .0001). The only variable that predicted an adverse neurological outcome was the presence of contralateral occlusion, which increased the likelihood of a perioperative neurological event seven-fold (P = .0038). Clinical outcomes in the 57 of 105 patients with abnormal baseline-EEGs and the 49 of 83 with prior CVA who were shunted were not different from those who were not. CONCLUSIONS: baseline-EEG is not of value for the prediction of adverse events during carotid endartectomy and can be eliminated. Because contralateral occlusion is highly predictive of changes with clamping, and patients undergoing a second carotid endartectomy will usually manifest EEG changes identical to those at the first, operative EEG monitoring can also be eliminated from both these circumstances. Finally, prior stroke does not lead to a higher incidence of clamp-induced EEG changes, and thus is not an indication for shunting in and of itself.

Duke Scholars

Published In

Cardiovasc Surg

DOI

ISSN

0967-2109

Publication Date

October 1998

Volume

6

Issue

5

Start / End Page

490 / 495

Location

England

Related Subject Headings

  • Risk Factors
  • Preoperative Care
  • Predictive Value of Tests
  • Postoperative Complications
  • Monitoring, Intraoperative
  • Intraoperative Complications
  • Incidence
  • Humans
  • Endarterectomy, Carotid
  • Electroencephalography
 

Citation

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MLA
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Illig, K. A., Burchfiel, J. L., Ouriel, K., DeWeese, J. A., Shortell, C. K., & Green, R. M. (1998). Value of preoperative EEG for carotid endarterectomy. Cardiovasc Surg, 6(5), 490–495. https://doi.org/10.1016/s0967-2109(98)00040-4
Illig, K. A., J. L. Burchfiel, K. Ouriel, J. A. DeWeese, C. K. Shortell, and R. M. Green. “Value of preoperative EEG for carotid endarterectomy.Cardiovasc Surg 6, no. 5 (October 1998): 490–95. https://doi.org/10.1016/s0967-2109(98)00040-4.
Illig KA, Burchfiel JL, Ouriel K, DeWeese JA, Shortell CK, Green RM. Value of preoperative EEG for carotid endarterectomy. Cardiovasc Surg. 1998 Oct;6(5):490–5.
Illig, K. A., et al. “Value of preoperative EEG for carotid endarterectomy.Cardiovasc Surg, vol. 6, no. 5, Oct. 1998, pp. 490–95. Pubmed, doi:10.1016/s0967-2109(98)00040-4.
Illig KA, Burchfiel JL, Ouriel K, DeWeese JA, Shortell CK, Green RM. Value of preoperative EEG for carotid endarterectomy. Cardiovasc Surg. 1998 Oct;6(5):490–495.
Journal cover image

Published In

Cardiovasc Surg

DOI

ISSN

0967-2109

Publication Date

October 1998

Volume

6

Issue

5

Start / End Page

490 / 495

Location

England

Related Subject Headings

  • Risk Factors
  • Preoperative Care
  • Predictive Value of Tests
  • Postoperative Complications
  • Monitoring, Intraoperative
  • Intraoperative Complications
  • Incidence
  • Humans
  • Endarterectomy, Carotid
  • Electroencephalography