Carotid endarterectomy: is an indwelling shunt necessary?

Three hundred and four consecutive endarterectomies were performed with general anesthesia and without a temporary indwelling shunt. Eight patients (2.6%) awoke from anesthesia with a new neurological deficit. Eight additional patients later developed neurological symptoms, suggesting that the absence of a shunt did not contribute to their complication. Of these 16 patients, two (0.6%) died, nine (3.0%) had a temporary neurological deficit, and five (1.6%) had a permanent neurological deficit. A prolonged occlusion time, a stump pressure of less than 50 mm Hg, or the presence of additional carotid lesions did not show a significant statistical relationship to postoperative neurological deficit.

[1]  R. Barnes,et al.  An evaluation of hypocarbia and hypercarbia during carotid endarterectomy. , 1976 .

[2]  W. Chung.  Long-term results of carotid artery surgery for cerebrovascular insufficiency. , 1974, American journal of surgery.

[3]  E. Wylie,et al.  Intraoperative measurement of carotid back pressure as a guide to operative management for carotid endarterectomy. , 1972, Surgery.

[4]  W. Edwards,et al.  Present status of carotid artery surgery in stroke prevention. , 1974, The American surgeon.

[5]  W. S. Fields,et al.  Joint study of extracranial arterial occlusion. V. Progress report of prognosis following surgery or nonsurgical treatment for transient cerebral ischemic attacks and cervical carotid artery lesions. , 1970 .

[6]  J. Severinghaus,et al.  Effect of CO2 and systemic hypertension on downstream cerebral arterial pressure during carotid endarterectomy. , 1971, Surgery.

[7]  A. D. Hall,et al.  Collateral cerebral blood pressure. An index of tolerance to temporary carotid occlusion. , 1973 .

[8]  D. Cooley,et al.  Increased tolerance to cerebral ischemia produced by general anesthesia during temporary carotid occlusion. , 1963, Surgery.

[9]  T. Sundt,et al.  Focal Transient Cerebral Ischemia in the Squirrel Monkey: EFFECT ON BRAIN ADENOSINE TRIPHOSPHATE AND LACTATE LEVELS WITH ELECTROCORTICOGRAPHIC AND PATHOLOGIC CORRELATION , 1972, Circulation research.

[10]  D. Cooley,et al.  Carotid endarterectomy without a shunt. Results using hypercarbic general anesthesia to prevent cerebral ischemia. , 1968, Archives of surgery.