Effects of carotid endarterectomy on motor evoked potentials elicited by transcranial magnetic stimulation

Katsoulas, George; Tsolakis, Ioannis A.; Polychronopoulos, Panagiotis; Αργέντου, Μαρία-Ιωάννα; Chroni, Elisabeth

doi:10.1007/s00415-005-0813-0

Cited by 7 publications

(4 citation statements)

References 15 publications

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“…[10][11][12] However, only a limited number of studies have investigated the validity of the MEP as a monitoring modality during CEA. 12,29 Uchino et al reported that the MEP amplitude significantly decreased in 4 of the 20 Japanese patients (20%) during carotid clamping, which is similar to the results of 2 of 10 patients (20%) in our study. 12 When a shunt tube was selectively used in CEA, 14 of 67 Korean patients ($ 20%) required shunting.…”

Section: Discussionsupporting

confidence: 90%

The Relationship between Carotid Stump Pressure and Changes in Motor-Evoked Potentials in Carotid Endarterectomy Patients

Hokari

Ito

Yamazaki

et al. 2016

J Neurol Surg A Cent Eur Neurosurg

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Background The threshold of ischemic tolerance has not been completely identified in human clinical studies. Distal carotid artery pressure can be easily measured through the internal shunt tube during carotid endarterectomy (CEA). To confirm the critical threshold of intracranial arterial pressure and its maximum duration, we investigated the distal internal carotid artery (ICA) pressure and motor-evoked potential (MEP) changes during ICA clamping. Material and Methods Between September 2012 and March 2014, 9 patients (10 sides) with carotid stenosis (70-99%) were surgically treated at our hospital. All CEAs were performed under general anesthesia, and we routinely used a carotid shunt with the intraoperative MEP monitors. When the MEP amplitude decreased to < 50% of the control during carotid clamping, the MEP amplitude was defined as significantly reduced. Results The MEP amplitude significantly decreased in 2 of the 10 procedures (20%) during ICA clamping. The mean distal ICA pressure varied widely, ranging from 13 to 48 mm Hg. In seven cases with a mean distal ICA pressure > 20 mm Hg, there were no significant changes in the MEP during ICA clamping. However, there were three cases with a mean distal ICA pressure < 20 mm Hg, and the MEP amplitude significantly decreased in two of those three patients from 4 to 5 minutes after clamping. Conclusions The present study provides considerable information about a higher incidence of MEP amplitude deterioration in CEA patients with a mean distal ICA pressure < 20 mm Hg during ICA clamping.

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Section: Discussionsupporting

confidence: 90%

The Relationship between Carotid Stump Pressure and Changes in Motor-Evoked Potentials in Carotid Endarterectomy Patients

Hokari

Ito

Yamazaki

et al. 2016

J Neurol Surg A Cent Eur Neurosurg

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“…More sensitive and focused measures have also been used to monitor motor physiology during carotid surgeries, for example transcranial electrical motor evoked potential stimulation in approximately 600 CEA patients, or somatosensory evoked potentials ( Malcharek et al, 2013 ; Uchino et al, 2012 ). Our findings support the validity of studies of motor cortex TMS excitability in patients at risk for vascular cognitive impairment ( Katsoulas et al, 2005 ; Lanza et al, 2017 ) and/or vascular depression ( Bella et al, 2011 ; Concerto et al, 2013 ; Pennisi et al, 2016 ). Whereas TMS motor cortex excitability alone cannot clearly distinguish vascular from other forms of degenerative burden such as Alzheimer's disease ( Pennisi et al, 2015 ), a logical follow-up study would be of changes in motor cortex excitability following lesions in motor cortex occurring during endovascular procedures.…”

Section: Discussionsupporting

confidence: 84%

Convergence Analysis of Micro-Lesions (CAML): An approach to mapping of diffuse lesions from carotid revascularization

Rosen

Soman

Bhat

et al. 2018

NeuroImage: Clinical

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Carotid revascularization (endarterectomy, stenting) prevents stroke; however, procedure-related embolization is common and results in small brain lesions easily identified by diffusion weighted magnetic resonance imaging (DWI). A crucial barrier to understanding the clinical significance of these lesions has been the lack of a statistical approach to identify vulnerable brain areas. The problem is that the lesions are small, numerous, and non-overlapping. Here we address this problem with a new method, the Convergence Analysis of Micro-Lesions (CAML) technique, an extension of the Anatomic Likelihood Analysis (ALE). The method combines manual lesion tracing, constraints based on known lesion patterns, and convergence analysis to represent regions vulnerable to lesions as probabilistic brain atlases. Two studies were conducted over the course of 12 years in an active, vascular surgery clinic. An analysis in an initial group of 126 patients at 1.5 T MRI was cross-validated in a second group of 80 patients at 3T MRI. In CAML, lesions were manually defined and center points identified. Brains were aligned according to side of surgery since this factor powerfully determines lesion distribution. A convergence based analysis, was performed on each of these groups. Results indicated the most consistent region of vulnerability was in motor and premotor cortex regions. Smaller regions common to both groups included the dorsolateral prefrontal cortex and medial parietal regions. Vulnerability of motor cortex is consistent with previous work showing changes in hand dexterity associated with these procedures. The consistency of CAML also demonstrates the feasibility of this new approach to characterize small, diffuse, non-overlapping lesions in patients with multifocal pathologies.

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“…Previously, Katsoulas et al reported the usefulness of MEP elicited by transcranial magnetic stimulation before and after CEA. However, this is the first report that validates the usefulness of transcranial MEP monitoring during CEA (14). As the results show, MEP monitoring was available in all but 1 patient who had moderate motor deficits (case 11).…”

Section: Mep Monitoringmentioning

confidence: 58%

Intraoperative Dual Monitoring During Carotid Endarterectomy Using Motor Evoked Potentials and Near-Infrared Spectroscopy

et al. 2012

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Effects of carotid endarterectomy on motor evoked potentials elicited by transcranial magnetic stimulation

Cited by 7 publications

References 15 publications

The Relationship between Carotid Stump Pressure and Changes in Motor-Evoked Potentials in Carotid Endarterectomy Patients

The Relationship between Carotid Stump Pressure and Changes in Motor-Evoked Potentials in Carotid Endarterectomy Patients

Convergence Analysis of Micro-Lesions (CAML): An approach to mapping of diffuse lesions from carotid revascularization

Intraoperative Dual Monitoring During Carotid Endarterectomy Using Motor Evoked Potentials and Near-Infrared Spectroscopy

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