Somatosensory evoked potentials in carotid artery stenting: Effectiveness in ascertaining cerebral ischemic events

Rupendra Bahadur Adhikari; Masaaki Takeda; Manish Kolakshyapati; Shigeyuki Sakamoto; Mizuki Morishige; Yoshihiro Kiura; Takahito Okazaki; Katsuhiro Shinagawa; Nobuhiko Ichinose; Satoshi Yamaguchi; Kaoru Kurisu

doi:10.1016/j.jocn.2016.01.026

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Somatosensory evoked potentials in carotid artery stenting: Effectiveness in ascertaining cerebral ischemic events

Journal article

Open access

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Somatosensory evoked potentials in carotid artery stenting: Effectiveness in ascertaining cerebral ischemic events

Rupendra Bahadur Adhikari, Masaaki Takeda, Manish Kolakshyapati, Shigeyuki Sakamoto, Mizuki Morishige, Yoshihiro Kiura, Takahito Okazaki, Katsuhiro Shinagawa, Nobuhiko Ichinose, Satoshi Yamaguchi, …

Journal of clinical neuroscience, Vol.30, pp.71-76

08/2016

DOI: 10.1016/j.jocn.2016.01.026

PMID: 27291465

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Abstract

•We report on the use of somatosensory evoked potential (SSEP) in carotid artery stenting (CAS).•Change in SSEP is highly specific and sensitive in ascertaining clinical stroke after CAS.•Prolonged SSEP changes positively correlate with complications.•SSEP in CAS is an effective tool in ascertaining cerebral ischemic events. Somatosensory evoked potentials (SSEP) have been used in various endovascular procedures and carotid endarterectomy, but to our knowledge no literature deals exclusively with the utility of SSEP in carotid artery stenting (CAS). The purpose of this study was to evaluate the efficacy of SSEP in detecting cerebral ischemic events during CAS. We conducted a prospective study in 35 CAS procedures in 31 patients during an 18month period. Thirty-three patients without near occlusion underwent stenting using dual protection (simultaneous flow reversal and distal filter) combined with blood aspiration, while two patients with near occlusion underwent stenting without dual protection. All 35 patients underwent SSEP monitoring. SSEP were generated by stimulating median and/or tibial nerves and recorded by scalp electrodes. During the aspiration phase post-dilation, seven patients (20%) exhibited SSEP changes with a mean duration of 11.3±8.5minutes (range: 3–25minutes), three of whom later developed minor stroke/transient ischemic attack. Diffusion-weighted imaging showed new lesions in 10 patients (28.6%). Change in SSEP exhibited mean sensitivity of 100% (95% confidence interval, 0.29–1.0) and specificity of 88% (95% confidence interval, 0.71–0.96) in predicting clinical stroke post-CAS. Intra-procedural SSEP change was predictive of post-procedural complications (p=0.005, Fisher’s exact test). Longer span of SSEP change was positively correlated with complications (p=0.032, Mann–Whitney test). Intra-procedural SSEP changes are highly sensitive in predicting neurological outcome following CAS. Chances of complications are increased with prolongation of such changes. SSEP allows for prompt intra-procedural ischemia prevention measures and stratification to pursue an aggressive peri-procedural protocol for high risk patients to mitigate neurological deficits.

Somatosensory evoked potentials

Stroke

Carotid artery stenting

Details

Title: Subtitle: Somatosensory evoked potentials in carotid artery stenting: Effectiveness in ascertaining cerebral ischemic events
Creators: Rupendra Bahadur Adhikari - Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
Masaaki Takeda - Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
Manish Kolakshyapati - Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
Shigeyuki Sakamoto - Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
Mizuki Morishige - Clinical Engineer Section, Clinical Support Department, Hiroshima University Hospital, Hiroshima, Japan
Yoshihiro Kiura - Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
Takahito Okazaki - Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
Katsuhiro Shinagawa - Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
Nobuhiko Ichinose - Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
Satoshi Yamaguchi - Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
Kaoru Kurisu - Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
Resource Type: Journal article
Publication Details: Journal of clinical neuroscience, Vol.30, pp.71-76
Publisher: Elsevier Ltd
DOI: 10.1016/j.jocn.2016.01.026
PMID: 27291465
ISSN: 0967-5868
eISSN: 1532-2653
Language: English
Date published: 08/2016
Academic Unit: Neurosurgery
Record Identifier: 9984040260002771

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