A Systematic Review to Assess the Diagnostic Performance and Clinical Utility of Intraoperative Neuromonitoring during Transcarotid Artery Revascularization.

Ann Vasc SurgJul 13, 2026 (epub)
Clinical ResearchVascular SurgeryNeurology

Ahsan Zil-E-Ali, Noor Fatima, Ibrahim Zulfiqar Ali et al.

✦ AI-curated · Sources linked

In 30 seconds

This systematic review assessed intraoperative neuromonitoring (IONM) during carotid revascularization, with particular focus on transcarotid artery revascularization (TCAR). It included five retrospective studies of 709 patients undergoing TCAR with IONM. Across studies, sensitivity and negative predictive value for immediate postoperative neurologic deficits were each reported as up to 100%; new deficits occurred in 0.4-3.4% of patients. Unresolved perfusion-related alerts were associated with greater risk of deficits, while most alerts resolved after intraoperative interventions. The review found that combined EEG and SSEP monitoring may improve diagnostic reliability, but called for prospective studies with standardized protocols.

Key findings

  • Across five retrospective studies involving 709 TCAR patients, IONM sensitivity and negative predictive value reached up to 100% for immediate postoperative neurologic deficits.
  • New neurologic deficits occurred in 0.4-3.4% of patients; positive predictive value varied by monitoring modality and alert definition.
  • Unresolved perfusion-related alerts were associated with higher risk of immediate postoperative deficits, while most alerts resolved after intraoperative interventions.
  • Transcranial Doppler and near-infrared spectroscopy showed transient cerebral blood-flow and oxygenation reductions during flow reversal, recovering after antegrade flow resumed.

Why it matters

IONM may help identify cerebral hypoperfusion during TCAR and provide a signal for intraoperative responses. Its reported high sensitivity and negative predictive value are potentially useful, but the low frequency of neurologic events limits positive predictive value. The findings support interest in multimodal monitoring while underscoring that its effect on patient outcomes and optimal use remain uncertain.

What to keep in mind

Evidence came from only five retrospective studies, and the review notes that prospective studies with standardized monitoring protocols are needed to establish IONM’s optimal role and impact on outcomes.

Source

PubMed · PMID 42442533

Published in Ann Vasc Surg. This summary was written by xxcode from the publication's abstract and metadata. It is not peer reviewed and is not a substitute for the original article. For clinical decisions, review the original publication.

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