Introduction

Intra-operative stroke (IOS) is associated with poor clinical outcome as detection is often delayed and time of symptom onset or patient's last known well (LKW) is uncertain. Intra-operative neurophysiological monitoring (IONM) is uniquely capable of detecting onset of neurological dysfunction in anesthetized patients, thereby precisely defining time last electrically well (LEW). This novel parameter may aid in the detection of large vessel occlusion (LVO) and prompt treatment with endovascular thrombectomy (EVT).

Methods

We performed a retrospective analysis of a prospectively maintained AIS and LVO database from May 2018-August 2019. Inclusion criteria required any surgical procedure under general anesthesia (GA) utilizing EEG (electroencephalography) and/or SSEP (somatosensory evoked potentials) monitoring with development of intraoperative focal persistent changes using predefined alarm criteria and who were considered for EVT.

Result

Five cases were identified. LKW to closure time ranged from 66 to 321 minutes, while LEW to closure time ranged from 43 to 174 min. All LVOs were in the anterior circulation. Angiography was not pursued in two cases due to large established infarct (both patients expired in the hospital). EVT was pursued in two cases with successful recanalization and spontaneous recanalization was noted in one patient (mRS 0–3 at 90 days was achieved in all 3 cases).

Conclusions

This study demonstrates that significant IONM changes can accurately identify patients with an acute LVO in the operative setting. Given the challenges of recognizing peri-operative stroke, LEW may be an appropriate surrogate to quickly identify and treat IOS.

中文翻译：

---

最后的良好电：术中神经生理学监测，用于大血管阻塞的识别和分类。

介绍

术中中风（IOS）与临床效果差有关，因为通常会延迟检测，并且症状发作的时间或患者的最后已知病情（LKW）尚不确定。术中神经生理监测（IONM）独特地能够检测麻醉患者的神经功能障碍的发作，从而精确定义电持续时间（LEW）。这个新颖的参数可能有助于检测大血管闭塞（LVO）并迅速进行血管内血栓切除术（EVT）的治疗。

方法

我们对2018年5月至2019年8月前瞻性维护的AIS和LVO数据库进行了回顾性分析。纳入标准要求在全身麻醉（GA）下使用EEG（脑电图）和/或SSEP（体感诱发电位）进行监测的任何手术方法，并监测其发展情况。术中局灶性持续变化，使用预定义的警报标准，并考虑使用EVT。

结果

确定了五例。LKW至关闭时间为66至321分钟，LEW至关闭时间为43至174分钟。所有LVO均在前循环中。由于严重的梗塞（两名患者均在医院中死亡），因此在两例中未进行血管造影检查。有2例患者成功进行了再通气治疗，并进行了EVT治疗，其中1例患者出现了自发性再通（3例患者在90天时mRS 0–3）。

结论

这项研究表明，IONM的显着变化可以在手术环境中准确识别出患有急性LVO的患者。鉴于识别围手术期卒中的挑战，LEW可能是快速识别和治疗IOS的适当替代方法。