A Comparative Study Of Two Methods Of Intraoperative Monitoring In Carotid Endarterectomy

Objective:A retrospective cohort study was conducted to investigate the effectiveness of evoked potential monitoring in monitoring cerebral perfusion during carotid endarterectomyMethods: a retrospective cohort survey in September 2013 January ~2017 December of continuous discharge of 59 consecutive patients who underwent carotid endarterectomy in the General Hospital of the Army Bayi Affiliated Brain Hospital,all patients were investigated by transcranial Doppler ultrasound(TCD)and intraoperative combined monitoring of evoked potential changes of cerebral blood flow;the intraoperative monitoring of TCD defaults to "the gold standard",according to statistics,set up monitoring of different time points,monitoring records of two monitoring methods.By drawing the four table,the calculation of brain evoked potential monitoring of hypoperfusion sensitivity,specificity,positive predictive value,negative predictive value,and will monitor the numerical and evoked potentials were TCD correlation analysis,comprehensive evaluation of the carotid artery resection accuracy of intraoperative monitoring of cerebral perfusion;in addition,through ROC curves to predict optimal induced perfusion in power shortage monitoring Threshold.Results: 1,Evoked potentials monitoring of Cerebral hypoperfusion in intraoperative;In the 59 patients,10 cases of patients who underwent the CEA operation achieved the diversion standard TCD monitoring after carotid artery occlusion.According to the situation in operation,the doctor of surgery carried out carotid internal–commom carotid artery bypass in 4 patients.The sensitivity,specificity,positive predictive value,negative predictive value of Somatosensory evoked potential amplitude decline in predicting intraoperative cerebral hypoperfusion were 60.00%,91.84%,60%,91.84%,diagnostic coincidence rate was 86.44%,Kapppa= 0.518;Pearson correlation coefficient r=0.707 of somatosensory evoked potential amplitude decline with the " gold standard " monitoring value(P<0.001);The sensitivity,specificity,positive predictive value,negative predictive value of somatosensory evoked potentials prolonged latent phase in predicting intraoperative cerebral hypoperfusion were 70.00%,93.88%,70.00%,93.88%,diagnostic coincidence rate was 89.83%,Kappa = 0.639;Pearson correlation coefficient r=0.498 of somatosensory evoked potentials prolonged latent phase with the " gold standard " monitoring value(P<0.001);ROC curve showed that somatosensory evoked potential amplitude decreased 51% compared to the baseline monitoring value after the carotid artery occlusion can predict better intraoperative hypoperfusion and the sensitivity,specificity respectively were 100.0% and 89.8%.The area under the curve was 0.918(95%CI 0.846~0.990),P<0.001;ROC curve showed that somatosensory evoked potentials prolonged latent phase >9.8% compared to the baseline monitoring value after the carotid artery occlusion can predict better intraoperative brain hypoperfusion and the sensitivity,specificity were 100%,92.9%,the area under the curve was 0.941(95%CI 0.878~0.995)P< 0.001.2,The sensitivity,specificity,positive predictive value,negative predictive value of motor evoked potential amplitude decline in prediction intraoperative cerebral hypoperfusion were30.00%%,97.96%,75%,87.27%,diagnostic coincidence rate was 86.44%,Kappa =0.361;Pearson correlation coefficient r=0.472 of motor evoked potential amplitude decline with the "gold standard" monitoring value(P<0.00 1.(3)the prognosis of the patients in this group: after the operation,the patients were examined whole nervous system and no ischemic brain injury occurred during the operationConclusion: Evoked potentials Intraoperative can real-time monitor cerebral blood flow continuously in carotid endarterectomy,predict better intraoperative cerebral hypoperfusion.In addition,evoked potentials can combine TCD monitoring for carotid endarterectomy cerebral blood flow monitoring.