Median somatosensory evoked potential as a predictor of clinical outcome after urgent surgical extracranial internal carotid artery recanalization |
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| Affiliation: | 1. Department of Neurology, České Budějovice Hospital, České Budějovice, Czech Republic;2. Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague and Military University Hospital, Prague, Czech Republic;3. Department of Neurosurgery, České Budějovice Hospital, České Budějovice, Czech Republic;4. Department of Neurosurgery, Faculty of Medicine in Plzeň, Charles University in Prague, Czech Republic |
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| Abstract: | ObjectiveChanges in the N20/P25 amplitude of somatosensory evoked potentials (SEP) of the median nerve have been found to correlate with those in cortical regional cerebral blood flow (rCBF). Our study presents the use of median nerve SEP amplitude in predicting the clinical outcome of urgent surgical internal carotid artery (ICA) recanalization.MethodsA total of 27 patients suffering an acute ischemic stroke (AIS) with extracranial ICA occlusion within 24 h were prospectively recruited. The primary preoperative endpoints included the SEP amplitude absolute value (SEP-amp) and the SEP amplitude side-to-side ratio (SEP-ratio).Clinical outcome at 3 months postoperatively was assessed using the modified Rankin scale (mRS-3M).ResultsThe positive predictive values (PPVs) for SEP-amp and SEP-ratio were 95.5% and 100%, respectively, with the negative predictive values (NPVs) being 60.0% and 100%, respectively. The SEP-ratio correlated fully with mRS-3M.ConclusionThe median SEP side-to-side N20/P25 amplitude ratio seems to be a very strong positive and negative predictor of the clinical outcome of urgent recanalization of an extracranial ICA occlusion.SignificanceThe results suggest that cortical evoked activity may help in selection patient for surgical recanalization and predict clinical recovery after an acute ischemic stroke. |
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| Keywords: | Somatosensory evoked potentials Evoked neuronal activity Amplitude ratio Outcome prediction Ischemic stroke Urgent recanalization AIS" },{" #name" :" keyword" ," $" :{" id" :" k0040" }," $$" :[{" #name" :" text" ," _" :" acute ischemic stroke ACA" },{" #name" :" keyword" ," $" :{" id" :" k0050" }," $$" :[{" #name" :" text" ," _" :" anterior cerebral artery CBF" },{" #name" :" keyword" ," $" :{" id" :" k0060" }," $$" :[{" #name" :" text" ," _" :" cerebral blood flow CEA" },{" #name" :" keyword" ," $" :{" id" :" k0070" }," $$" :[{" #name" :" text" ," _" :" carotid endarterectomy cerebral metabolic rate of oxygen CCA" },{" #name" :" keyword" ," $" :{" id" :" k0090" }," $$" :[{" #name" :" text" ," _" :" common carotid artery CST" },{" #name" :" keyword" ," $" :{" id" :" k0100" }," $$" :[{" #name" :" text" ," _" :" corticospinal tract DWI" },{" #name" :" keyword" ," $" :{" id" :" k0110" }," $$" :[{" #name" :" text" ," _" :" diffusion weighted image FLAIR" },{" #name" :" keyword" ," $" :{" id" :" k0120" }," $$" :[{" #name" :" text" ," _" :" fluid-attenuated inversion recovery DNT" },{" #name" :" keyword" ," $" :{" id" :" k0130" }," $$" :[{" #name" :" text" ," _" :" median door-to-needle time DTF" },{" #name" :" keyword" ," $" :{" id" :" k0140" }," $$" :[{" #name" :" text" ," _" :" door-to-flow time ICA" },{" #name" :" keyword" ," $" :{" id" :" k0150" }," $$" :[{" #name" :" text" ," _" :" internal carotid artery IQR" },{" #name" :" keyword" ," $" :{" id" :" k0160" }," $$" :[{" #name" :" text" ," _" :" interquartile ratio IVT" },{" #name" :" keyword" ," $" :{" id" :" k0170" }," $$" :[{" #name" :" text" ," _" :" intravenous LAO" },{" #name" :" keyword" ," $" :{" id" :" k0180" }," $$" :[{" #name" :" text" ," _" :" large artery occlusion MEP" },{" #name" :" keyword" ," $" :{" id" :" k0190" }," $$" :[{" #name" :" text" ," _" :" motor MRC" },{" #name" :" keyword" ," $" :{" id" :" k0200" }," $$" :[{" #name" :" text" ," _" :" Medical Research Council score MRC-UE" },{" #name" :" keyword" ," $" :{" id" :" k0210" }," $$" :[{" #name" :" text" ," _" :" Medical Research Council score upper extremity MRC-LE" },{" #name" :" keyword" ," $" :{" id" :" k0220" }," $$" :[{" #name" :" text" ," _" :" Medical Research Council score lower extremity MCA" },{" #name" :" keyword" ," $" :{" id" :" k0230" }," $$" :[{" #name" :" text" ," _" :" middle cerebral artery mRS" },{" #name" :" keyword" ," $" :{" id" :" k0240" }," $$" :[{" #name" :" text" ," _" :" modified Rankin scale mRS-3M" },{" #name" :" keyword" ," $" :{" id" :" k0250" }," $$" :[{" #name" :" text" ," _" :" modified Rankin scale 3 months after surgery MT" },{" #name" :" keyword" ," $" :{" id" :" k0260" }," $$" :[{" #name" :" text" ," _" :" mechanic thrombectomy MTT" },{" #name" :" keyword" ," $" :{" id" :" k0270" }," $$" :[{" #name" :" text" ," _" :" mean transit time NIHSS" },{" #name" :" keyword" ," $" :{" id" :" k0280" }," $$" :[{" #name" :" text" ," _" :" National Institute of Health Stroke Scale NIHSS-door" },{" #name" :" keyword" ," $" :{" id" :" k0290" }," $$" :[{" #name" :" text" ," _" :" National Institute of Health Stroke Scale on admission NIHSS-CEA" },{" #name" :" keyword" ," $" :{" id" :" k0300" }," $$" :[{" #name" :" text" ," _" :" National Institute of Health Stroke Scale before surgery NPV" },{" #name" :" keyword" ," $" :{" id" :" k0310" }," $$" :[{" #name" :" text" ," _" :" negative predictive value OTF" },{" #name" :" keyword" ," $" :{" id" :" k0320" }," $$" :[{" #name" :" text" ," _" :" onset-to-flow time PMC" },{" #name" :" keyword" ," $" :{" id" :" k0330" }," $$" :[{" #name" :" text" ," _" :" primary motor cortex PPV" },{" #name" :" keyword" ," $" :{" id" :" k0340" }," $$" :[{" #name" :" text" ," _" :" positive predictive value rCBF" },{" #name" :" keyword" ," $" :{" id" :" k0350" }," $$" :[{" #name" :" text" ," _" :" regional cerebral blood flow SEP" },{" #name" :" keyword" ," $" :{" id" :" k0360" }," $$" :[{" #name" :" text" ," _" :" somatosensory evoked potential SEP-amp" },{" #name" :" keyword" ," $" :{" id" :" k0370" }," $$" :[{" #name" :" text" ," _" :" somatosensory evoked potential amplitude SEP-ratio" },{" #name" :" keyword" ," $" :{" id" :" k0380" }," $$" :[{" #name" :" text" ," _" :" somatosensory evoked potential amplitude side-to-side ratio TIA" },{" #name" :" keyword" ," $" :{" id" :" k0390" }," $$" :[{" #name" :" text" ," _" :" transient ischemic attack |
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