The Results of Carotid Surgery Trialists of Ege University: Effectiveness of EEG Monitorization and Selective Shunting in Carotid Endarterectomy

Abstract

Between 1990 and 1998, 76 patients were ındergone carotid endarterectomy. The group I containing 22 patients (%28.9) operated between 1990-1993 was compared with the group II containing 54 patients (%71.1) operated with brain monitorization (EEG) between 1993-1998. In group I, shunting was applicated to all eight patients (36.6%) who bad contralateral carotid disease and one of them had stroke postoperatively. In the group II shunts were placed for only six patients (11.1%) who had major EEG changes suggestive of iscgemia with carotid clamping. Among these 6 patients only one had contralateral carotid disease. Although they had contralateral carotid disease, shunts were not applicated to 30 patients (55.5%) replaced in group II according to evaluations of EEG activity. One stroke had occured in group, two strokes (14.3%) ocuredden in the patients who had shunts placed. There was not any significant difference related to postoperative stroke incidence between first and EEG monitorized second groups and between the patients who had contralateral disease and who had not. But a remarkable difference related to stroke rates was found between the patients shunted and nonshunted. At the conclusion, by guidance of EEG monitorization carotid endarterectomy can be performed safely without using a temporary shunt in spite of the existence of contralateral carotid disease. EEG monitorization can identify patients with significantly higher risk of intraoperative stroke. It can make the surgeon enable to work in a comfortable operative condition and prevents the complications of unnecessary shunt application.