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

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Abstract

Background

Neuromonitoring 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.

Purpose

To determine the effectiveness of near infrared spectroscopy (NIRS) compared to multimodality intraoperative neuromonitoring (IONM) in indicating elective shunts and predicting postoperative neurological status.

Methods

This 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.

Results

NIRS 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%).

Conclusion

NIRS is inferior to multimodality IONM in detecting brain ischemia and predicting postoperative neurological status during CEA under general anesthesia.

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Acknowledgements

Nothing to disclose.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. 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

    Julio Plata-Bello & Helga Fariña-Jerónimo

  2. Department of Neurology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain

    Pedro Javier Pérez-Lorensu, Ángel Saponaro-González & José María Domínguez-Lorenzo

  3. Department of Anesthesiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain

    Beneharo Darias-Delbey, Roberto Ucelay-Gómez, Enrique Francisco González-Tabares, Zena Ibrahim-Achi, Christian Salvador Guerrero-Ramírez, Carol Elizabeth Padrón-Encalada & José Luis Pérez-Burkhardt

  4. Department of Vascular Surgery, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain

    Beneharo Darias-Delbey

Authors
  1. Julio Plata-Bello
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  2. Pedro Javier Pérez-Lorensu
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Pedro Perez-Lorensu, Ángel Saponaro-González and José María Domínguez-Lorenzo. The first draft of the manuscript was written by Julio Plata-Bello and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Julio Plata-Bello.

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The study was approved by the local Ethics Committee in January 2017 (code 2017_76).

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Plata-Bello, J., Pérez-Lorensu, P.J., Saponaro-González, Á. et al. Can NIRS be a surrogate indicator of elective shunt in carotid endarterectomy? A single-center observational retrospective study says no. J Clin Monit Comput (2023). https://doi.org/10.1007/s10877-023-01114-1

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