Carotid endarterectomy: To shunt or not to shunt

Mary K. Gumerlock, Edward A. Neuwelt

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Because of controversies in the cerebrovascular literature regarding the use of an intraluminai shunt in carotid endarterectomy, we report a randomized prospective study of 118 consecutive symptomatic patients receiving surgery within a single neurosurgical practice. Over 4 years, 138 carotid endarterectomies were performed in the 118 patients, 63 operations with intraluminai shunting and 75 without. Standard rationale for surgery included ipsilateral cerebral infarction in 38% of the operations and ipsilateral transient ischemic attacks in 36%. Unilateral angiographic stenosis of >90% was seen in 58% of the operations; there were no ipsilateral occlusions. Surgery was performed under general anesthesia with barbiturate induction and mild blood pressure elevation. The 30-day complication rate included a mortality rate of 0.7% with a 5.1% incidence of postoperative neurologic deficit and a 1.4% rate of myocardial infarction. In the 24 hours after surgery there were no cerebral infarctions in the shunted group and six in the unshunted group. This 8% rate in the unshunted group compared with 0% in the shunted group was significant at p=0.023 with a power of 0.95 by Fisher’s exact test and X2analysis. This suggests that in our neurosurgical practice (resident training program) the use of an intraluminai shunt during carotid endarterectomy significantly reduces the risk of intraoperative neurologic deficit without increasing the incidence of other complications.

Original languageEnglish (US)
Pages (from-to)1482-1484
Number of pages3
JournalStroke
Volume19
Issue number12
StatePublished - Dec 1988

Keywords

  • Arteriovenous shunt
  • Endarterectomy
  • Surgical

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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    Gumerlock, M. K., & Neuwelt, E. A. (1988). Carotid endarterectomy: To shunt or not to shunt. Stroke, 19(12), 1482-1484.