Introduction: Mechanical endovascular therapy (MET) is a promising adjuvant therapy for acute ischemic stroke caused by occlusion of a large vessel. However, only selected patients will potentially benefit from reperfusion. Real time monitoring of recanalisation success with regard to functional outcome is not possible because these procedures are usually performed in general anaesthesia. Herein, we present a novel application for evoked potential for real time monitoring of reperfusion success with respect to functional outcome during MET for acute ischemic stroke.
Methods: Prospective observational study from 03/12 until 04/2013 of patients presenting with acute ischemic stroke that are eligible for MET. Transcranial motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs) were applied during MET. The monitoring data were reviewed independently and related to clinical and radiological outcomes during follow-up. MEPs and SSEPs were measured throughout the intervention. Neurological outcome was assessed by the modified Rankin Scale and National Institutes of Health Stroke Scale at 0, 7 and 90 days following intervention.
Results: 20 patients were examined. MEPs and SSEPs were successful in 19 (95%) and 13 (65%) cases, respectively. There were 9, 7 and 4 patients with occlusion of the medial cerebral artery, internal carotid artery and basilar artery, respectively. Successful reperfusion was achieved in 16 cases (TICI -Reperfusions-Grad 2b or 3). MEPs sensitivity and specificity were 90.9% and 87.5% respectively. SSEPs sensitivity and specificity were 71.4% and 83.3%, respectively.
Conclusions: MEPs and SSEPs are safe and feasible methods of real time monitoring of reperfusion success with respect to functional outcome during MET for acute ischemic stroke. MEPs have higher rates of sensitivity and specificity than SSEP and seem better suited in such a setting in which a rapid setup is crucial
Patient Care: This feasibility study may encourage other group to use this novel application.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of neurophysiological monitoring during mechanical endovascular therapy for acute ischemic stroke.