Arterial collateral anatomy predicts the risk for intra-operative changes in somatosensory evoked potentials in patients
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ORIGINAL ARTICLE - VASCULAR NEUROSURGERY - OTHER
Arterial collateral anatomy predicts the risk for intra-operative changes in somatosensory evoked potentials in patients undergoing carotid endarterectomy: a prospective cohort study Mandy D. Müller 1 & Kathleen Seidel 1 & Giovanni Peschi 2 & Eike Piechowiak 2 & Pascal J. Mosimann 2 & Philippe Schucht 1 & Andreas Raabe 1 & David Bervini 1 Received: 8 September 2020 / Accepted: 16 October 2020 # The Author(s) 2020
Abstract Background During carotid endarterectomy (CEA), significant amplitude decrement of somatosensory evoked potentials (SEPs) is associated with post-operative neurological deficits. Objective To investigate the association between an incomplete circle of Willis and/or contralateral ICA occlusion and subsequent changes in intra-operatively monitored SEPs. Methods We performed a retrospective analysis of a single center, prospective cohort of consecutive patients undergoing CEA over a 42-month period after reviewing the collateral arterial anatomy on pre-operative radiological imaging. The primary endpoint was an intra-operative decline in SEPs > 50% compared to the baseline value during arterial cross-clamping. Univariate and multivariate logistic regression analyses were performed to investigate a potential association between contralateral ICA occlusion, incomplete circle of Willis, and subsequent alteration in SEPs. Results A total of 140 consecutive patients were included, of which 116 patients (82.9%) had symptomatic carotid stenosis of at least 50% according to the classification used in the North American Carotid Surgery Trial (NASCET) (Stroke 22:711–720, 1991). Six patients (4.3%) showed contralateral ICA occlusion, 22 patients (16%) a missing/hypoplastic anterior communicating artery (Acom) or A1 segment, and 79 patients (56%) a missing ipsilateral posterior communicating artery (Pcom) or P1 segment. ICA occlusion and missing segments of the anterior circulation (missing A1 and/or missing Acom) were associated with the primary endpoint (p = 0.003 and p = 0.022, respectively). Conclusion Contralateral ICA occlusion and missing anterior collaterals of the circle of Willis increase the risk of intra-operative SEP changes during CEA. Pre-operative assessment of collateral arterial anatomy might help identifying patients with an increased intra-operative risk. Keywords Carotid endarterectomy . Neuromonitoring . Surgical morbidity . Cerebrovascular disease . Risks assessment . Vascular anatomy
Introduction
This article is part of the Topical Collection on Vascular Neurosurgery Other * David Bervini [email protected] 1
Department of Neurosurgery, Inselspital, Bern University Hospital and University of Bern, 3010 Bern, Switzerland
2
Department of Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
Carotid stenosis is an important cause of stroke. Carotid endarterectomy (CEA) reduces the risk for ipsilateral stroke in patients with symptomatic and asymptomatic carotid stenosis. [8, 18] Generally,
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