Intraoperative electroencephalographic changes during transcarotid artery revascularization are more frequent than previously reported

Thrombosis or vasospasm: The utility of intraoperative neuromonitoring during TCAR

“…6 More study, however, is warranted to establish the prognostic ability of neuromonitoring to detect clinically relevant changes during TCAR and the potential to reduce subsequent stroke. 26 As part of our TCAR algorithm is the routine use of neuromonitoring, which was borne out of early experience with TCAR in its infancy. In order to facilitate rapid conversion to carotid endarterectomy if needed, we initially started with a vertical incision and had neuromonitoring during the operation.…”

“…These findings are not in isolation, however, with Healy et al describing a retrospective review of two urban hospitals between 2017 and 2020. 26 The authors report a total of 89 patients undergoing TCAR during the study period with 79.8% receiving intraoperative EEG neuromonitoring, of which 9 patients (12.7%) expeirenced EEG changes. The authors state that the changes resolved in seven patients with pressure augmentation and switching to the low-flow toggle but one patient who had sustained EEG changes was found to have a new postoperative neurological deficit.…”

“…6 More study, however, is warranted to establish the prognostic ability of neuromonitoring to detect clinically relevant changes during TCAR and the potential to reduce subsequent stroke. 26…”