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Open Access 01-06-2021 | Carotid Stenosis | Original Article - Vascular Neurosurgery - Other

Arterial collateral anatomy predicts the risk for intra-operative changes in somatosensory evoked potentials in patients undergoing carotid endarterectomy: a prospective cohort study

Authors: Mandy D. Müller, Kathleen Seidel, Giovanni Peschi, Eike Piechowiak, Pascal J. Mosimann, Philippe Schucht, Andreas Raabe, David Bervini

Published in: Acta Neurochirurgica | Issue 6/2021

Abstract

Background

During carotid endarterectomy (CEA), significant amplitude decrement of somatosensory evoked potentials (SEPs) is associated with post-operative neurological deficits.

Objective

To investigate the association between an incomplete circle of Willis and/or contralateral ICA occlusion and subsequent changes in intra-operatively monitored SEPs.

Methods

We performed a retrospective analysis of a single center, prospective cohort of consecutive patients undergoing CEA over a 42-month period after reviewing the collateral arterial anatomy on pre-operative radiological imaging. The primary endpoint was an intra-operative decline in SEPs > 50% compared to the baseline value during arterial cross-clamping. Univariate and multivariate logistic regression analyses were performed to investigate a potential association between contralateral ICA occlusion, incomplete circle of Willis, and subsequent alteration in SEPs.

Results

A total of 140 consecutive patients were included, of which 116 patients (82.9%) had symptomatic carotid stenosis of at least 50% according to the classification used in the North American Carotid Surgery Trial (NASCET) (Stroke 22:711–720, 1991). Six patients (4.3%) showed contralateral ICA occlusion, 22 patients (16%) a missing/hypoplastic anterior communicating artery (Acom) or A1 segment, and 79 patients (56%) a missing ipsilateral posterior communicating artery (Pcom) or P1 segment. ICA occlusion and missing segments of the anterior circulation (missing A1 and/or missing Acom) were associated with the primary endpoint (p = 0.003 and p = 0.022, respectively).

Conclusion

Contralateral ICA occlusion and missing anterior collaterals of the circle of Willis increase the risk of intra-operative SEP changes during CEA. Pre-operative assessment of collateral arterial anatomy might help identifying patients with an increased intra-operative risk.

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Title: Arterial collateral anatomy predicts the risk for intra-operative changes in somatosensory evoked potentials in patients undergoing carotid endarterectomy: a prospective cohort study
Authors: Mandy D. Müller
Kathleen Seidel
Giovanni Peschi
Eike Piechowiak
Pascal J. Mosimann
Philippe Schucht
Andreas Raabe
David Bervini
Publication date: 01-06-2021
Publisher: Springer Vienna
Keywords: Carotid Stenosis
Somatosensory Evoked Potential
Carotid Endarterectomy
Carotid Stenosis
Somatosensory Evoked Potential
Published in: Acta Neurochirurgica / Issue 6/2021
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-020-04624-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Arterial collateral anatomy predicts the risk for intra-operative changes in somatosensory evoked potentials in patients undergoing carotid endarterectomy: a prospective cohort study

Abstract

Background

Objective

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusion

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