Evidence map›Paper›PMID 42859268›Full record

ArticleLangenbeck's archives of surgery2026

Neuromonitoring of perioperative microembolization and its association with postoperative stroke after carotid endarterectomy.

Mohammed Al-Falahi, Jelle Frankort, Gabriel Schima, Bernhard Hruschka, Quentin Cappel, Werner Mess, Christian Uhl, Alexander Gombert, Panagiotis Doukas

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Article in Langenbeck's archives of surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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2 · The registry

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Mohammed Al-FalahiDepartment of Vascular Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany. malfalahi@ukaachen.de.
Jelle FrankortDepartment of Vascular Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Gabriel SchimaDepartment of Vascular Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Bernhard HruschkaDepartment of Vascular Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Quentin CappelDepartment of Vascular Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Werner MessDepartment of Clinical Neurophysiology, MUMC +, Maastricht, The Netherlands.
Christian UhlDepartment of Vascular Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Alexander GombertDepartment of Vascular Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Panagiotis DoukasDepartment of Vascular Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThis study aims to assess whether perioperative microembolization can identify patients at risk for postoperative stroke.

methodsA total of 257 carotid endarterectomy procedures in 254 patients were analyzed (154 symptomatic, 103 asymptomatic). Neuromonitoring, combining transcranial Doppler ultrasonography and continuous electroencephalography, was utilized to evaluate cerebral perfusion and detect microembolic signals (MES). Monitoring covered the entire intraoperative phase and a standardized 20-minute postoperative observation window.

resultsPostoperative stroke occurred in seven patients, six of whom were symptomatic prior to the procedure. In exploratory penalized regression analyses, higher postoperative MES counts (OR 1.02 per MES, 95% CI 1.01-1.04; p < 0.001) and an intraoperative burden of ≥ 10 MES (OR 6.06, 95% CI 1.40-34.78; p = 0.016) were associated with postoperative stroke. Symptomatic patients exhibited a significantly higher embolic burden (6.7 ± 13.3 vs. 2.2 ± 5.0, p = 0.004).

conclusionBeyond its role in guiding selective shunting, transcranial Doppler monitors the occurrence of microembolization, which could serve as a potential indicator of perioperative stroke. In this exploratory analysis, both an intraoperative burden of 10 or more MES and sustained postoperative microembolization were associated with postoperative stroke. Given the low number of events, these findings are hypothesis-generating and require prospective validation before they can guide perioperative management.

Indexed as

Carotid StenosisEndarterectomy, CarotidIntracranial EmbolismPostoperative ComplicationsStrokeAgedElectroencephalographyFemaleHumansMaleMiddle AgedRisk FactorsUltrasonography, Doppler, TranscranialCarotid artery stenosisCarotid endarterectomyIntraoperative neuromonitoringMicroembolic signalsPerioperative strokeTranscranial Doppler ultrasonography

Identifiers

PMID42859268
PMCPMC13653865

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