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Monday, August 24, 2009

NeuroMonitoring Cuts Stroke Risk of Carotid Surgery?

In this Elsevier medical news, Kerri writes about how utilizing neuromonitoring could cut the risks of stroke during carotid surgery, this is not a new report, but for those who missed this news article,
you can read it here.

Neuromonitoring Cuts Stroke Risk Of Carotid Surgery
Elsevier Global Medical News

ORLANDO — Targeted neuromonitoring can dramatically reduce stroke complications during and after carotid endarterectomy, according to one expert speaking at the annual meeting of the American Society of Neuroimaging. “A targeted monitoring strategy— and I stress the word targeted— has virtually eliminated intraoperative stroke and stroke due to postoperative carotid thrombosis in our unit,” said A. Ross Naylor, M.D., professor of vascular surgery at the University of Leicester in England. Carotid endarterectomy (CEA) carries a small but important
risk of stroke for both symptomatic and asymptomatic patients. Although neuromonitoring can be an effective way to minimize the risks associated with carotid endarterectomy,
here is “more to monitoring than deciding who needs a bit of plastic tubing shoved into their artery. You have to ask the right questions, and then you’ll start to get the right answers.” Dr. Naylor reported that his team uses continuous transcranial Doppler (TCD) sonography
and completion angioscopy for intraoperative monitoring. “We ask very limited questions
of transcranial Doppler,” he said. The group tries to maintain a mean middle cerebral artery velocity greater than 15 cm/sec. Hemodynamic failure is usually not the problem. “I have
seen over 1,200-1,500 carotids now in our unit, and I cannot ascribe hemodynamic failure to
any patient.” Technical errors and thrombosis are the more likely culprits. TCD reveals
shunt malfunctions and “is the only method capable of diagnosing on-table thrombosis,” he said.
Dr. Naylor and his team use ....