Neurologic injury remains a significant, potentially devastating complication of major vascular surgeries such as carotid stenting, carotid endarterectomy, aortic aneurysm repair and open heart surgeries. Stroke and ischemia are the two primary neurological adverse events of vascular surgeries. Both of these complications lead to more time in the intensive care unit, longer stays in the hospital, and higher morbidity and mortality rates.
One lesser-known fact about the human body is that the vessels that supply blood may differ drastically from that of your neighbor—as could the location of certain arteries in your body. These individual anatomical differences can affect a patient’s surgical outcome. Before surgery, patients might undergo radiological tests to help delineate what their particular vessels look like, but these preoperative assessments cannot account for the dynamic processes that take place during the vascular surgery itself.
This is where intraoperative neuromonitoring comes in.
Intraoperative neuromonitoring can help prevent neurologic injury during vascular procedures in a way that preoperative measures alone cannot. Intraoperative neuromonitoring, or IONM, involves the monitoring of the peripheral and the central nervous systems while in surgery. In real-time, IONM tracks the status of the nervous system during procedures that could compromise it. IONM can help identify neurologic challenges early enough to trigger measures that can prevent nervous system damage. It can also assist the surgeon with clinical decision-making both during surgery and throughout the recovery period.
Different vascular surgeries call for different IONM modalities. IONM that works well during a carotid endarterectomy will not always be optimal for an aortic procedure. Your surgeon along with your Neuro Alert Surgical Neurophysiologist and Remote Reading Physician can determine the modality that is best-suited not only to the procedure but the patient. These modalities may include:
- Motor evoked potential
- Somatosensory evoked potential
- Brainstem auditory evoked potentials
The understanding of these modalities and the interpretation of the results can lead to improved outcomes for patients undergoing major vascular surgeries.