Early Outcomes of Routine Delayed Shunting in Carotid Endarterectomy for Asymptomatic Patients

Abstract

Routine delayed shunting associated with standardisation of the technique seems to be a safe and effective technique and contributes to maintaining the RNCR < 1% over time and independently from operators and other clinical factors.

Five-year outcome of non-shunting and primary closure technique during carotid endarterectomy: a longitudinal cohort study

“…In contrast, surgeons who do not recommend shunting refer to several reports from the literature showing that shunting might be inessential in around 85% of patients and that possible complications include arterial dissection, air emboli, and acute occlusion. 11 …”

“…In contrast, surgeons who do not recommend shunting refer to several reports from the literature showing that shunting might be inessential in around 85% of patients and that possible complications include arterial dissection, air emboli, and acute occlusion. 11 Goodney et al 12 focused on complete contralateral ICA in patients requiring CEA procedures and found a higher riskadjusted chance of death or stroke when shunts were used by surgeons who did not use them routinely. Aburahma et al 10 reviewed several studies and concluded that routine ICA shunting during CEA and selective shunting had similar results in terms of perioperative stroke and 30-day mortality.…”

Clamped Carotid Dissection Can Reduce Postoperative Stroke After Carotid Endarterectomy

“…15,16 An NIRS reduction greater than 15% from basal levels is considered significant 15,16 and warrants more expeditious endarterectomy in an effort to minimize cerebral hypoperfusion time; otherwise, the CEA is performed, and the shunt is inserted only after complete plaque removal; this is not the standard approach, as many surgeons shunt the carotid prior of plaque removal, but shunting after plaque removal was demonstrated to be similarly effective, and it is our routinely approach. 12 The present retrospective analysis underlines that CD can reduce the incidence of early postoperative strokes, especially in symptomatic patients. In this context, it is interesting to note that with the CD technique, the incidence of perioperative stroke in asymptomatic patients is as low as 4%.…”

Clinical Impact of Routine Cardiology Consultation Prior to Elective Carotid Endarterectomy in Neurologically Asymptomatic Patients

“…CEA was performed by vascular surgeons following a standardised surgical technique used during the whole study period, with the use of total intravenous or inhalation general anaesthesia, continuous EEG monitoring, and routine "delayed" shunt insertion after plaque removal. 18,19 Two methods of endarterectomy were used: standard CEA followed by polytetrafluoroethylene patch closure for straight internal carotid arteries (ICA); and eversion CEA for kinking/coiling of the ICA. The procedure was performed under systemic heparinisation with a standard dose of 5000 units.…”