Carotid Endarterectomy Surgeries: A Multimodality Intraoperative Neurophysiological Monitoring Approach

Role of Intraoperative Neurophysiological Monitoring in Predicting Postoperative Delirium in Patients Undergoing Carotid Endarterectomy Surgeries

INTRODUCTION

This study aimed to evaluate the diagnostic utility of electroencephalography (EEG) and somatosensory evoked potentials (SSEP) as modalities of intraoperative neurophysiological monitoring (IONM) in predicting postoperative delirium (POD) in patients who underwent carotid endarterectomy (CEA) surgery.

METHODS

A total cohort of 425 patients was included in this study. Medical record data were reviewed retrospectively and their documented significant IONM data were analyzed and integrated into the study for each patient. The study cohort was assessed for POD with the Intensive Care Delirium Screening Checklist (ICDSC), and a score of >4 was positive for delirium.

RESULTS

Of the 425 patients who underwent CEA for carotid stenosis, 65 (15.29%) had documented significant IONM changes. Of those 65 patients with significant changes, 16 (24.61%) had POD. On the other hand, of the 360 patients without changes, 31 (8.61%) had POD. Utilizing logistic regression while adjusting for possible confounders, IONM changes were still significantly associated with POD (p value: <0.001; 95% confidence interval (CI): 1.91-7.98; adjusted odds ratio (ORadj): 3.94). Specifically, SSEP changes alone were significantly associated with POD (p value: <0.001; 95% CI: 2.36-11.08; ORadj: 5.15).

CONCLUSION

Significant IONM changes increase the risk of developing POD in patients undergoing CEA. Despite the low overall risk of POD after CEA in our study, it is imperative to conclude that patients with POD are twice as likely to exhibit IONM changes.

Post-Stroke Brain Health Monitoring and Optimization: A Narrative Review

Significant advancements have been made in recent years in the acute treatment and secondary prevention of stroke. However, a large proportion of stroke survivors will go on to have enduring physical, cognitive, and psychological disabilities from suboptimal post-stroke brain health. Impaired brain health following stroke thus warrants increased attention from clinicians and researchers alike. In this narrative review based on an open timeframe search of the PubMed, Scopus, and Web of Science databases, we define post-stroke brain health and appraise the body of research focused on modifiable vascular, lifestyle, and psychosocial factors for optimizing post-stroke brain health. In addition, we make clinical recommendations for the monitoring and management of post-stroke brain health at major post-stroke transition points centered on four key intertwined domains: cognition, psychosocial health, physical functioning, and global vascular health. Finally, we discuss potential future work in the field of post-stroke brain health, including the use of remote monitoring and interventions, neuromodulation, multi-morbidity interventions, enriched environments, and the need to address inequities in post-stroke brain health. As post-stroke brain health is a relatively new, rapidly evolving, and broad clinical and research field, this narrative review aims to identify and summarize the evidence base to help clinicians and researchers tailor their own approach to integrating post-stroke brain health into their practices.