scholarly journals Comparison of Near-Infrared Spectroscopy and Somatosensory Evoked Potentials for the Detection of Cerebral Ischemia During Carotid Endarterectomy

Stroke ◽  
1998 ◽  
Vol 29 (10) ◽  
pp. 2032-2037 ◽  
Author(s):  
Ulrich Beese ◽  
Harald Langer ◽  
Werner Lang ◽  
Michael Dinkel
Keyword(s):  
Infrared Spectroscopy ◽  
Cerebral Ischemia ◽  
Evoked Potentials ◽  
Carotid Endarterectomy ◽  
Near Infrared Spectroscopy ◽  
Somatosensory Evoked Potentials ◽  
Near Infrared

Defining thresholds for critical ischemia by using near-infrared spectroscopy in the adult brain

1998 ◽  
Vol 89 (3) ◽  
pp. 389-394 ◽  
Author(s):  
Peter J. Kirkpatrick ◽  
Joseph Lam ◽  
Pippa Al-Rawi ◽  
Piotr Smielewski ◽  
Marek Czosnyka
Keyword(s):  
Infrared Spectroscopy ◽  
Cerebral Ischemia ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Adult Brain ◽  
Content Type ◽  
Signal Changes ◽  
Fine Print

Object. Signal changes in adult extracranial tissues may have a profound effect on cerebral near-infrared spectroscopy (NIRS) measurements. During carotid surgery NIRS signals provide the opportunity to determine the relative contributions from the intra- and extracranial vascular territories, allowing for a more accurate quantification. In this study the authors applied multimodal monitoring methods to patients undergoing carotid endarterectomy and explored the hypothesis that NIRS can define thresholds for cerebral ischemia, provided extracranial NIRS signal changes are identified and removed. Relative criteria for intraoperative severe cerebral ischemia (SCI) were applied to 103 patients undergoing carotid endarterectomy. Methods. One hundred three patients underwent carotid endarterectomy. An intraoperative fall in transcranial Doppler—detected middle cerebral artery flow velocity (%ΔFV) of greater than 60% accompanied by a sustained fall in cortical electrical activity were adopted as criteria for SCI. Ipsilateral frontal NIRS recorded the total difference in concentrations of oxyhemoglobin and deoxyhemoglobin (Total ΔHbdiff). Interrupted time series analysis following clamping of the external carotid artery (ECA) and the internal carotid artery (ICA) allowed the different vascular components of Total ΔHbdiff (ECA ΔHbdiff and ICA ΔHbdiff) to be identified. Data obtained in 76 patients were deemed suitable. A good correlation between %ΔFV and ICA ΔHbdiff (r = 0.73, p < 0.0001) was evident. Sixteen patients (21%) fulfilled the criteria for SCI. All patients who demonstrated an ICA ΔHbdiff of greater than 6.8 µmol/L showed SCI, and in two patients within this group nondisabling watershed infarction developed, as seen on postoperative computerized tomography scans. No patient with an ICA ΔHbdiff less than 5 µmol/L exhibited SCI or suffered a stroke. Within the resolution of the criteria used an ICA ΔHbdiff threshold of 6.8 µmol/L provided 100% specificity for SCI, whereas an ICA ΔHbdiff less than 5 µmol/L was 100% sensitive for excluding SCI. When Total ΔHbdiff was used without removing the ECA component, no thresholds for SCI were apparent. Conclusions. Carotid endarterectomy provides a stable environment for exploring NIRS-quantified thresholds for SCI in the adult head.

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

2012 ◽  
Vol 78 (6) ◽  
pp. 651-657 ◽  
Author(s):  
Haruto Uchino ◽  
Toshitaka Nakamura ◽  
Satoshi Kuroda ◽  
Kiyohiro Houkin ◽  
Jun-ichi Murata ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Evoked Potentials ◽  
Carotid Endarterectomy ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Motor Evoked Potentials

Abstract 2412: Intraoperative Dual Monitoring during Carotid Endarterectomy Using Motor Evoked Potential and Near-infrared Spectroscopy

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Haruto Uchino ◽  
Toshitaka Nakamura ◽  
Satoshi Kuroda ◽  
Kiyohiro Houkin ◽  
Jun-ichi Murata ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Cerebral Ischemia ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Near Infrared Spectroscopy ◽  
Evoked Potential ◽  
Near Infrared ◽  
Perioperative Complications ◽  
Motor Evoked Potential ◽  
Motor Deficit

Objective: Carotid endarterectomy (CEA) is a useful procedure to prevent subsequent ischemic stroke in patients with severe stenosis of internal carotid artery. However, lowering of morbidity is still essential to keep its clinical significance. This study aimed to evaluate the validity of dual monitoring using transcranial motor evoked potential (MEP) and near-infrared spectroscopy (NIRS) during CEA. Methods: Transcranial MEP and NIRS monitoring were conducted in 20 consecutive CEA. MEP was recorded in the contralateral extremities. Regional cerebral saturation of oxygen (rSO2) was continuously measured in the ipsilateral forehead. The changes of MEP amplitudes and rSO2 during cross-clamping of carotid artery were compared in each case. Results: The amplitudes of MEP significantly decreased when rSO2 reduced to more than 20% during carotid clamping. There was a significant correlation between the changes of MEP amplitude and rSO2 during carotid clamping in a quadratic manner (P<.001, r=0.821). However, NIRS could not detect critical cerebral ischemia in one patient with cerebral infarction in the ipsilateral frontal lobe. On the other hand, MEP could not identify it in one patient with severe motor deficit. No perioperative complication occurred. Conclusion: These findings strongly suggest that both MEP and NIRS can detect critical cerebral ischemia during CEA in most of patients. Dual MEP and NIRS monitoring may further increase the sensitivity to identify it, being valuable to prevent perioperative complications due to cerebral ischemia during CEA.

Sign in / Sign up

Export Citation Format

Share Document