The aim of this study is to understand how patients undergoing carotid endarterectomy with continuous electroencephalographic (EEG) neuromonitoring require shunt placement because of EEG changes. Initial studies of transcarotid artery revascularization (TCAR) found only one patient with temporary EEG changes. We report our experience with intraoperative EEG monitoring during TCAR. We conducted a retrospective review of patients from May 2017 to January 2020 who received TCAR at two urban hospitals within an integrated health care network. Data included demographic information, patient comorbidities, symptom status, prior carotid interventions, anatomic details, contralateral disease, intraoperative vital signs and EEG changes, and postoperative major adverse events (transient ischemic attack, stroke, myocardial infarction, and death) both initially and 30 days postoperatively. Fisher exact test was used for categorical data; continuous data were analyzed with Wilcoxon rank sum. A total of 89 patients underwent TCAR during the study period, of whom 71 (79.8%) had intraoperative EEG neuromonitoring; Median carotid stenosis percentage on preoperative computed tomography angiography was lower for patients with EEG changes than for those without (67% vs 80%; P = .009).


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