• J Clin Monit Comput · Dec 2023

    Can NIRS be a surrogate indicator of elective shunt in carotid endarterectomy? A single-center observational retrospective study says no.

    • Julio Plata-Bello, Pedro Javier Pérez-Lorensu, Ángel Saponaro-González, Beneharo Darias-Delbey, Helga Fariña-Jerónimo, José María Domínguez-Lorenzo, Roberto Ucelay-Gómez, Enrique Francisco González-Tabares, Zena Ibrahim-Achi, Christian Salvador Guerrero-Ramírez, Carol Elizabeth Padrón-Encalada, and José Luis Pérez-Burkhardt.
    • Department of Neurosurgery, Hospital Universitario de Canarias, Carretera Ofra s/n La Cuesta. CP 38320. La Laguna, S/C de Tenerife, Santa Cruz de Tenerife, Spain. jplabel@gobiernodecanarias.org.
    • J Clin Monit Comput. 2023 Dec 8.

    BackgroundNeuromonitoring during carotid endarterectomy (CEA) under general anesthesia is desirable and may be useful for preventing brain ischemia, but the selection of the most appropriate method remains controversial.PurposeTo determine the effectiveness of near infrared spectroscopy (NIRS) compared to multimodality intraoperative neuromonitoring (IONM) in indicating elective shunts and predicting postoperative neurological status.MethodsThis is a retrospective observational study including 86 consecutive patients with CEA under general anesthesia. NIRS and multimodality IONM were performed during the procedure. IONM included electroencephalography (EEG), somatosensory evoked potentials (SSEPs) and transcranial motor-evoked potentials (TcMEPs). Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated for each neuromonitoring modality.ResultsNIRS presented a sensitivity and a specificity for detecting brain ischemia of 77.7% and 89.6%, respectively (PPV = 46.6% and NPV = 97.2%). In contrast, a 100% sensitivity and specificity for multimodality IONM was determined (PPV and NPV = 100%). No significant difference (in demographical or clinical data) between "true positive" and "false-positive" patients was identified. Among the methods included in multimodality IONM, EEG showed the best results for predicting postoperative outcome after CEA (PPV and NPV=100%).ConclusionNIRS is inferior to multimodality IONM in detecting brain ischemia and predicting postoperative neurological status during CEA under general anesthesia.© 2023. The Author(s), under exclusive licence to Springer Nature B.V.

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