Neurol Clin 24 (2006) 631–645 Prevention of Ischemic Neurologic Injury With Intraoperative Monitoring of Selected Cardiovascular and Cerebrovascular Procedures: Roles of Electroencephalography, Somatosensory Evoked Potentials, Transcranial Doppler, and Near-Infrared Spectroscopy Michael A. Sloan, MD, MSa,b,* aDivision of Neurology, Neuroscience and Spine Institute, Carolinas Medical Center, Charlotte, NC, USA bUniversity of North Carolina at Chapel Hill, Chapel Hill, NC, USA The United States Census estimates that there will be 40 million Ameri- cans ages 65 and older in 2010 [1]. The aging population undoubtedly will result in an increased occurrence of chronic diseases, such as cardiovascular (coronary and aortic) and cerebrovascular (carotid artery) diseases, which will lead to an increasing number of surgical and interventional procedures. The American Heart Association estimates that of 709,000 open-heart pro- cedures performed in 2002, 515,000 were coronary artery bypass grafting (CABG) procedures [2]. Postoperative neurologic complications, including cerebral infarction and encephalopathy, occur in up to 15% of patients who undergo CABG surgery. In addition, neuropsychologic testing can doc- ument behavioral abnormalities in up to 70% of patients [3–11]. The risk of stroke after CABG can be predicted based on characteristics known before surgery [8,11–16]. Carotid endarterectomy (CEA) is the noncardiac vascular procedure performed most frequently, with 134,000 procedures performed * Carolinas Medical Center, Neuroscience and Spine Institute, Division of Neurology, 1010 Edgehill Road North, Charlotte, NC 28207. E-mail address:
[email protected] 0733-8619/06/$ - see front matter Ó 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.ncl.2006.05.002 neurologic.theclinics.com 632 SLOAN in the United States in 2002.