RESUMO
Objective To compare the accuracy of somatosensory evoked potentials(SSEPs), motor evoked potentials(MEPs), regional cerebral oxygen saturation(rSO2)and multimodal monitoring in monitoring cerebral ischemia in patients undergoing carotid endarterectomy(CEA). Methods Eighty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 46-76 yr, scheduled for elective CEA, were enrolled in the study. SSEPs, MEPs and rSO2were monitored during CEA. The event of intraoperative cerebral ischemia was defined as:(1)SSEP escape latency prolongation of 10% and∕or amplitude decrease of 50%;(2)disappearance of MEP amplitude;(3)decrease in rSO2>20% of the baseline value;(4)When multimodal monitoring was applied, the event of intraopera-tive cerebral ischemia could be defined as long as one variable previously described met the condition. The gold standard of perioperative cerebral ischemia was defined as:(1)the National Institutes of Health Stroke Scale score≥4 at 1, 3 and 5 days after operation than before operation was considered as neurologi-cal dysfunction;(2)cranial CT showed a new ipsilateral cerebral focal ischemia, and postoperative in-tracranial hemorrhage diseases were excluded. Results Five cases developed cerebral ischemia after opera-tion. The sensitivity and specificity of SSEPs in predicting cerebral ischemia were 80% and 83%, respec-tively;MEPs 80% and 80%, respectively; SSEPs+MEPs 100% and 79%, respectively; rSO260% and 93%, respectively;SSEPs+MEPs+rSO2100% and 7%, respectively. Decrease in rSO2> 20% of the base-line value was consistent with SSEP escape latency prolongation of 10% and∕or amplitude decrease of 50%in diagnosis of cerebral ischemia(Kappa value 0.67, P<0.01); decrease in rSO2>20% of the baseline value was consistent with disappearance of MEP amplitude in diagnosis of cerebral ischemia(Kappa value 0.54, P<0.01). Conclusion rSO2has a good agreement with SSEPs and MEPs in diagnosis of cerebral ischemia during CEA; combination of SSEPs and MEPs produces better accuracy in monitoring cerebral is-chemia.
RESUMO
Objective To evaluate the diagnostic value of 64 multidetector-row CT angiography for internal carotid artery(ICA)stenosis and the application in the follow-up of carotid endarterectomy and percutaneous transluminal stenting.Methods Forty transient ischemie attack(TIA)patients with interpretable CTA and DSA of the cervical carotid arteries were selected from May 2005 to December 2005. This yielded a total of 80 vessels.The CTA curved planar reformations(CPR)and DSA images referenced to the distal cervical internal carotid were graded by two senior neuroradiologists blindly,according to the North American Symptomatic Carotid Endarterectomy Trial(NASCET)guidelines.The paired-t test was used to verify the statistical significant difference between pre-operating and post-operating of carotid endarterectomy or percutaneous transluminal stenting in measuring the vascular diameter and area of cross section using CTA.Results When the 70% stenosis was used as the cut-off value,the seasitivity,specificity,negative predictive value,and the positive predicting value were 97%,95%,95%,and 98%,respectively.There was statistically significant difference in measuring the vascular diameter(P