EEG monitoring of carotid endarterectomy with routine patch-graft angioplasty: an experience in a large series

Near-death experiences between science and prejudice

“…Anesthesia can suppress consciousness by simply interrupting binding and integration between local brain areas without the need for suppressing EEG activity (Alkire and Miller, 2005; Alkire et al, 2008). This is the reason why, in clinical practice, general anesthesia can be associated with almost normal EEG with peak activity in the alpha band (Facco et al, 1992), while in deep, irreversible coma, consciousness can be lost even with a preserved alpha pattern activity (Facco, 1999; Kaplan et al, 1999). In short, loss of consciousness can occur with preserved EEG activity, while, in the case of a flat EEG, neither cortical activity nor binding can occur; furthermore, short latency somatosensory-evoked potentials, which explore the conduction through brain stem up to the sensory cortex and are more resistant to ischemia than EEG, have been reported to disappear during cardiac arrest (Yang et al, 1997).…”

Shunting during carotid endarterectomy

“…These observations appear to be true, even in the face of contralateral ICA occlusion. Facco et al 22 reported their experience in 439 CEAs, and shunts were only used in patients who showed clamprelated EEG abnormalities (24%); however, patients with contralateral carotid artery occlusion had a 70% rate of EEG clamp-related changes. The perioperative stroke rate was 1.6% and the death rate was 0.69%.…”

“…The optimal method for evaluating cerebral perfusion during CEA and to determine the need for selective shunting is also controversial. In patients undergoing CEA under general anesthesia, several investigators prefer electroencephalogram (EEG) monitoring, [22][23][24][25][26][27][28][29] while others prefer transcranial Doppler (TCD), [30][31][32][33][34][35] carotid stump pressure (SP) measurements, 14,[36][37][38][39][40][41][42][43][44][45] somatosensory evoked potential (SSEP), [46][47][48][49][50][51][52][53][54][55] or cerebral oximetry monitoring 56,57 to determine the need for shunting. Meanwhile, for patients undergoing CEA with regional anesthesia, selective shunting can be based on alterations in the neurological examination that develop after carotid clamping.…”

The utility of adjunctive electroencephalography while performing transcarotid artery revascularization

“…Without adjunctive shunting, CEA has been associated with cerebral hypoperfusion during the period of blood flow interruption, with rates of intraoperative stroke estimated between 3% and 5% 16, 17, 18. The use of EEG has been shown to decrease intraoperative stroke rates below 0.8% for CEA 19 , 20 . Clamping in CEA has been associated with EEG abnormalities, appearing in 14% to 49.1% of patients undergoing CEA 19 , 21 , 22 .…”