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Case Reports
. 2019 Nov 9;5(4):456-460.
doi: 10.1016/j.jvscit.2019.09.008. eCollection 2019 Dec.

The utility of adjunctive electroencephalography while performing transcarotid artery revascularization

Drew J Braet  1 , Naveen Balasundaram  1 , Tiffany S Meller  1 , Jonathan Bath  1 , Todd R Vogel  1
Affiliations
Case Reports

The utility of adjunctive electroencephalography while performing transcarotid artery revascularization

Drew J Braet et al. J Vasc Surg Cases Innov Tech. .

Abstract

Transcarotid artery revascularization (TCAR) has been used as an alternative to carotid endarterectomy and transfemoral carotid artery stenting. Although TCAR has been associated with a decrease in perioperative strokes compared with transfemoral carotid artery stenting, little is known about the safety of cerebral blood during flow reversal or the value of adjunctive electroencephalography (EEG) monitoring in performing TCAR. We describe two cases of EEG changes in patients undergoing TCAR. These cases highlight the use of adjunctive EEG and provide examples of test clamping to assess for compromised collateral cerebral blood flow in patients undergoing TCAR.

Keywords: Electroencephalogram; Neuroprotection; Transcarotid artery revascularization.

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Figures

Fig 1
Fig 1
A, Maximum intensity projection of head and neck before transcarotid artery revascularization (TCAR) showing high-grade stenosis of the right internal carotid artery (ICA). B, Three-dimensional reconstructed computed tomography angiography image showing intact circle of Willis.
Fig 2
Fig 2
Electroencephalogram before (A) and after (B) clamping of the common carotid artery (CCA). The baseline electroencephalogram reveals symmetric alpha and theta waves from the left to the ride side. The blue lines depict activity of the left side of the brain; the red lines depict activity of the right side. After clamping of the CCA, a loss of amplitude and wave complexity was seen, reflecting changes on the right side of the brain (arrow). The anesthesia blood pressure tracing reveals augmentation of systolic blood pressure to approximately 180 mm Hg from 120 mm Hg (C).
Fig 3
Fig 3
A, Three-dimensional reconstructed computed tomography angiography image of head and neck before transcarotid artery revascularization (TCAR) showing high-grade stenosis of the left internal carotid artery (ICA). B, Maximum intensity projection showing intact circle of Willis.
Fig 4
Fig 4
Electroencephalogram before (A) and after (B) clamping of the common carotid artery (CCA). The baseline electroencephalogram reveals symmetric alpha and theta waves from the left to the ride side. The blue lines depict activity of the left side of the brain; the red lines depict activity of the right side. After clamping of the CCA, a loss of amplitude and wave complexity was seen, reflecting changes on the left side of the brain (arrow). The anesthesia blood pressure tracing reveals augmentation of systolic blood pressure to approximately 150 mm Hg from 120 mm Hg (C).
See this image and copyright information in PMC

References

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