Neurophysiological monitoring with brainstem evoked potentials can be a valuable tool for patients undergoing vertebrobasilar stenting and angioplasty-initial experience.

INTRODUCTION

Brainstem auditory evoked potentials (BAEPs) are routinely used during a variety of intracranial surgeries involving the posterior fossa and endovascular procedures including coiling of cerebral aneurysms. However, use of BAEPs has not been reported in vertebrobasilar stenting.

METHODS

Six patients underwent stenting and angioplasty of the basilar artery (four) or the dominant vertebral artery (two) for symptomatic stenosis. All the patients received stenting and angioplasty with Wingspan stent and Gateway balloon, respectively. Continuous real time BAEPs were recorded in all patients, and somatosensory evoked potentials in five patients.

RESULTS

All the patients had successful stenting and angioplasty in their target vessels. All the procedures were done under general anesthesia. In five patients, there were no significant changes in the BAEP responses during the predilation, stenting, and postdilation. There were no postprocedural neurological deficits in these patients. In one patient, there was a 1-ms increase of latency of wave V at the time of predilation angioplasty. No changes in the amplitude of wave V were noted. This patient had immediate postprocedure left hemiplegia, which improved to power of 3/5 in both upper and lower limbs at the time of discharge and to 4/5 at 3-month follow-up. Computed tomography scan did not show any evidence of hemorrhage.

CONCLUSIONS

Brainstem auditory evoked potentials may be a valuable monitoring tool in patients undergoing stenting and angioplasty of vertebrobasilar system. Early signs of brainstem dysfunction can be identified to modify the procedure and reduce neurological deficits. Large studies are needed to validate the use of BAEP during this procedure.