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. 1980 Jun;191(6):708–714. doi: 10.1097/00000658-198006000-00008

Carotid endarterectomy without temporary intraluminal shunt. Study of 309 consecutive operations.

D A Ott, D A Cooley, L Chapa, A Coelho
PMCID: PMC1344778  PMID: 7387232

Abstract

A prospective study was undertaken to determine the efficacy of performing carotid endarterectomy without an intraluminal shunt. During a two-year period, 240 patients, ranging in age from 36 to 89 years, underwent 309 consecutive carotid endarterectomies. The indication for operation was transient ischemic attacks in 151 (63%) patients, asymptomatic carotid bruit in 67 (28%), and previous stroke in 22 (9%). Internal shunts were not used in any patients and all arteriotomies were patched with a preclotted knitted Dacron velor patch. Systemic heparinization was used during the procedure. The early postoperative mortality was 0.64% (2/309). Both deaths were caused by myocardial infarction. The incidence of stroke after operation was 1.29% (4/309). Neither carotid clamp time nor the presence of contralateral disease correlated with the occurrence of postoperative stroke. According to results of angiography, 22 patients had total occlusion of the contralateral internal carotid artery with satisfactory intracranial circulation. No postoperative strokes occurred in this subgroup. Results of this study revealed that equally good or superior results may be obtained without a temporary shunt in performing carotid endarterectomy.

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Selected References

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  1. Baker J. D., Gluecklich B., Watson C. W., Marcus E., Kamat V., Callow A. D. An evaluation of electroencephalographic monitoring for carotid study. Surgery. 1975 Dec;78(6):787–794. [PubMed] [Google Scholar]
  2. Baker W. H., Dorner D. B., Barnes R. W. Carotid endarterectomy: is an indwelling shunt necessary? Surgery. 1977 Sep;82(3):321–326. [PubMed] [Google Scholar]
  3. Blaisdell W. F., Clauss R. H., Galbraith J. G., Imparato A. M., Wylie E. J. Joint study of extracranial arterial occlusion. IV. A review of surgical considerations. JAMA. 1969 Sep 22;209(12):1889–1895. [PubMed] [Google Scholar]
  4. Bloodwell R. D., Hallman G. L., Keats A. S., Cooley D. A. Carotid endarterectomy without a shunt. Results using hypercarbic general anesthesia to prevent cerebral ischemia. Arch Surg. 1968 Apr;96(4):644–652. doi: 10.1001/archsurg.1968.01330220160025. [DOI] [PubMed] [Google Scholar]
  5. COOLEY D. A., AL-NAAMAN Y. D., CARTON C. A. Surgical treatment of arteriosclerotic occlusion of common carotid artery. J Neurosurg. 1956 Sep;13(5):500–506. doi: 10.3171/jns.1956.13.5.0500. [DOI] [PubMed] [Google Scholar]
  6. Collins G. J., Jr, Rich N. M., Andersen C. A., McDonald P. T. Stroke associated with carotid endarterectomy. Am J Surg. 1978 Feb;135(2):221–225. doi: 10.1016/0002-9610(78)90104-6. [DOI] [PubMed] [Google Scholar]
  7. Connolly J. E., Kwaan J. H., Stemmer E. A. Improved results with carotid endarterectomy. Ann Surg. 1977 Sep;186(3):334–342. doi: 10.1097/00000658-197709000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cooley D. A., Hallman G. L. Surgical treatment of extracranial cerebral vascular occlusive disease. Conn Med. 1968 Nov;32(11):820–824. [PubMed] [Google Scholar]
  9. DeWeese J. A., Rob C. G., Satran R., Marsh D. O., Joynt R. J., Lipchik E. O., Zehl D. N. Endarterectomy for atherosclerotic lesions of the carotid artery. J Cardiovasc Surg (Torino) 1971 Jul-Aug;12(4):299–308. [PubMed] [Google Scholar]
  10. Fields W. S., Maslenikov V., Meyer J. S., Hass W. K., Remington R. D., Macdonald M. 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. JAMA. 1970 Mar 23;211(12):1993–2003. doi: 10.1001/jama.211.12.1993. [DOI] [PubMed] [Google Scholar]
  11. Haynes C. D., Dempsey R. L. Carotid endarterectomy: review of 276 cases in a community hospital. Ann Surg. 1979 Jun;189(6):758–762. doi: 10.1097/00000658-197906000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hays R. J., Levinson S. A., Wylie E. J. Intraoperative measurement of carotid back pressure as a guide to operative management for carotid endarterectomy. Surgery. 1972 Dec;72(6):953–960. [PubMed] [Google Scholar]
  13. Hertzer N. R., Beven E. G., Greenstreet R. L., Humphries A. W. Internal carotid back pressure, intraoperative shunting, ulcerated atheromata, and the incidence of stroke during carotid endarterectomy. Surgery. 1978 Mar;83(3):306–312. [PubMed] [Google Scholar]
  14. Nunn D. B. Carotid endarterectomy: an analysis of 234 operative cases. Ann Surg. 1975 Dec;182(6):733–738. doi: 10.1097/00000658-197512000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Okies J. E., MacManus Q., Starr A. Myocardial revascularization and carotid endarterectomy: a combined approach. Ann Thorac Surg. 1977 Jun;23(6):560–563. doi: 10.1016/s0003-4975(10)63702-2. [DOI] [PubMed] [Google Scholar]
  16. Patterson R. H., Jr Risk of carotid surgery with occlusion of the contralateral carotid artery. Arch Neurol. 1974 Feb;30(2):188–189. doi: 10.1001/archneur.1974.00490320076014. [DOI] [PubMed] [Google Scholar]
  17. Prioleau W. H., Jr, Alken A. F., Hairston P. Carotid endarterectomy: neurologic complications as related to surgical techniques. Ann Surg. 1977 Jun;185(6):678–683. doi: 10.1097/00000658-197706000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Rich N. M., Hobson R. W., 2nd Carotid endarterectomy under regional anesthesia. Am Surg. 1975 Apr;41(4):253–259. [PubMed] [Google Scholar]
  19. Smith L. L., Jacobson J. G., Hinshaw D. B. Correlation of neurologic complications and pressure measurements during carotid endarterectomy. Surg Gynecol Obstet. 1976 Aug;143(2):233–236. [PubMed] [Google Scholar]
  20. Sundt T. M., Jr, Sharbrough F. W., Anderson R. E., Michenfelder J. D. Cerebral blood flow measurements and electroencephalograms during carotid endarterectomy. J Neurosurg. 1974 Sep;41(3):310–320. doi: 10.3171/jns.1974.41.3.0310. [DOI] [PubMed] [Google Scholar]
  21. Sundt T. M., Sandok B. A., Whisnant J. P. Carotid endarterectomy. Complications and preoperative assessment of risk. Mayo Clin Proc. 1975 Jun;50(6):301–306. [PubMed] [Google Scholar]
  22. Thompson J. E., Austin D. J., Patman R. D. Carotid endarterectomy for cerebrovascular insufficiency: long-term results in 592 patients followed up to thirteen years. Ann Surg. 1970 Oct;172(4):663–679. doi: 10.1097/00000658-197010000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Thompson J. E., Patman R. D., Talkington C. M. Asymptomatic carotid bruit: long term outcome of patients having endarterectomy compared with unoperated controls. Ann Surg. 1978 Sep;188(3):308–316. doi: 10.1097/00000658-197809000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Urschel H. C., Razzuk M. A., Gardner M. A. Management of concomitant occlusive disease of the carotid and coronary arteries. J Thorac Cardiovasc Surg. 1976 Dec;72(6):829–834. [PubMed] [Google Scholar]
  25. Waltz A. G., Sundt T. M., Jr, Michenfelder J. D. Cerebral blood flow during carotid endarterectomy. Circulation. 1972 May;45(5):1091–1096. doi: 10.1161/01.cir.45.5.1091. [DOI] [PubMed] [Google Scholar]
  26. Young J. R., Humphries A. W., Beven E. G., DeWolfe V. G. Carotid endarterectomy without a shunt. Experiences using hyperbaric general anesthesia. Arch Surg. 1969 Sep;99(3):293–297. doi: 10.1001/archsurg.1969.01340150001001. [DOI] [PubMed] [Google Scholar]

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