Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting)

An international, multispecialty, expert-based Delphi Consensus document on controversial issues in the management of patients with asymptomatic and symptomatic carotid stenosis

“…In addition to numerous studies addressing this issue, this topic has been the subject of Cochrane Database Systematic Reviews since 2000 and has been updated four times. [78][79][80][81][82] The first Cochrane Database Systematic Review in 2000 concluded that the data at the time were too limited to either support or refute the use of routine or selective shunting in CEA. 78 It was also suggested that large-scale RCTs of routine vs selective shunting were required.…”

“…The same conclusions have been reached in all subsequent Cochrane Database Systematic Reviews since then, including the latest one published in 2022. [79][80][81][82] Vascular surgeons tend to be routine, selective, or never shunters, based on their training. Although there are several methods to monitor brain perfusion during carotid clamping (eg, electroencephalography, stump pressure, backflow, transcranial Doppler monitoring, transcranial cerebral oximetry, and near-infrared spectroscopy), the only reliable method is the patient's neurological status with CEA under locoregional anesthesia.…”

Case of Amaurosis Fugax in the Setting of a Persistent Primitive Hypoglossal Artery Requiring Carotid Endarterectomy with Regional Anesthesia

“…Our case avoided such complications by utilizing regional anesthesia and conscious sedation to monitor neurologic function for the duration of the procedure. Systematic reviews outline uncertainty with respect to approaches to shunting and intraoperative monitoring when CEA is performed under general anesthesia [ 22 ]. Previous CEA in patients with PPAH performed under general anesthesia have used multimodal neurophysiological monitoring and shunting [ 18 ].…”