The Impact of Neurophysiological Monitoring on Patient Outcomes in Carotid Endarterectomy: A Meta-Analysis
DOI:
https://doi.org/10.5281/zenodo.12588227Keywords:
Meta-analysis, carotid endarterectomy, CEA, intraoperative neurophysiological monitoring, IONM, electroencephalogram, EEG, somatosensory evoked potentials, SSEP, SEP, transcranial doppler, ultrasound, TCDAbstract
The 30-day stroke rate following a Carotid Endarterectomy (CEA) ranges between 2-6% and is associated with a three-fold increase in mortality. Various types of Intraoperative Neurological Monitoring (IONM) modalities are available to help detect changes in cerebral blood flow during this procedure. The primary aim of this meta-analysis was to evaluate the efficacy of the different (IONM) techniques used for this surgery and compare them to multiple modality studies. We identified relevant articles on PubMed (2000-2024), EBSCOhost (2000-2024), and Science Direct (2000-2024) to identify studies to include in this meta-analysis. We included literature that consisted of adult patients who underwent a CEA procedure under general anesthesia and were monitored with the specified IONM modalities. We calculated the mean specificities and sensitivities for each IONM Modality studied and are as follows: mean EEG sensitivity 41% and specificity 90%; mean TCD sensitivity 99% and specificity 83%; mean SSEP sensitivity 64% and specificity 88%; combined SSEP+EEG sensitivity 59% and specificity 99%. Each IONM modality presents its own unique set of challenges to determine severe deficits in cerebral blood flow. Given the high specificity or sensitivity observed across virtually all modalities, additional studies are needed to assess the effectiveness of combining the strengths of two modalities to enhance their capabilities.
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