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Intraoperative changes in somatosensory evoked potentials as predictors of perioperative stroke in carotid endarterectomy

Meinert, Justin (2018) Intraoperative changes in somatosensory evoked potentials as predictors of perioperative stroke in carotid endarterectomy. Undergraduate Thesis, University of Pittsburgh. (Unpublished)

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Abstract

Intro: Perioperative stroke is a known but severe neurological complication that can occur after
carotid endarterectomy (CEA). Perioperative stroke has been shown to increase the risk of
morbidity and mortality in the short and long term. Intraoperative neurophysiological monitoring
with somatosensory evoked potentials (SSEPs) is utilized to warn the surgical team of impending
neurological deficits. Our goal for this study is to quantitatively evaluate the diagnostic value of
SSEP changes in predicting perioperative stroke during CEA.

Method: We identified all perioperative strokes during the hospital stay. We further classified
them into major and minor strokes. To quantitatively assess SSEP changes, amplitudes and
latencies of the cortical SSEP responses were measured during various critical and consistent
times during CEA.

Results: There is a significant difference in amplitude between controls and perioperative
strokes at all time points after pre-incision, not including the end of the surgery. Patients with
perioperative strokes had significantly decreased amplitude from all four baselines. The area
under the curve for ROC curve analysis of pre incision amplitude change was greater than
incision, heparin, and pre-clamp. A decrease greater than 50% of amplitude was predictive of
perioperative stroke and major strokes alone from all baselines.

Discussion: It should be considered that the purpose of an alarm is to present a warning in which
an intervention is still possible to prevent the occurrence of a perioperative stroke. It should be
recommended that a pre-incision baseline is used during CEA. The alarm criteria should be
moved to provide an appropriate cushion to allow intervention. Latency changes were very
specific but have limited sensitivity, and do not appear to be very useful, especially at the current
alarm criteria of a 10% increase.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Meinert, Justinjwm77@pitt.edujwm77
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairThirumala, Parthathirumalapd@upmc.edu
Committee MemberSesack, Susansesack@pitt.edu
Committee MemberBalzer, Jeffbalzjr@upmc.edu
Committee MemberScheuer, Markscheuerml@persyst.com
Date: 26 April 2018
Date Type: Publication
Defense Date: 19 March 2018
Approval Date: 26 April 2018
Submission Date: 20 April 2018
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 36
Institution: University of Pittsburgh
Schools and Programs: University Honors College
Dietrich School of Arts and Sciences > Neuroscience
Degree: BPhil - Bachelor of Philosophy
Thesis Type: Undergraduate Thesis
Refereed: Yes
Uncontrolled Keywords: SSEP, CEA, Carotid, Endarterectomy, Somatosensory, Evoked, Potentials, Amplitude change, Intraoperative Monitoring
Date Deposited: 26 Apr 2018 15:59
Last Modified: 26 Apr 2018 15:59
URI: http://d-scholarship.pitt.edu/id/eprint/34361

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