North Pacific Surgical Association
Results of routine shunting and patch closure during carotid endarterectomy

Presented at the North Pacific Surgical Association Annual Meeting, Vancouver, BC, Canada, November 11–12, 2011.
https://doi.org/10.1016/j.amjsurg.2011.12.005Get rights and content

Abstract

Background

The role of shunting and patching during carotid endarterectomy remains controversial.

Methods

This is a retrospective case series evaluating consecutive patients undergoing carotid endarterectomy with routine shunting and patching. The primary endpoints were perioperative stroke, arterial injury, and lesion recurrence by duplex.

Results

Of the 220 operations performed, 43% were for symptomatic disease. Successful shunt placement occurred in 98%, with no shunt-related injuries. There was 1 minor perioperative stroke and no major strokes. At a mean follow-up of 24 months (median = 12 months), there was 1 restenosis potentially related to shunt placement. The incidence of asymptomatic >50% stenosis in the patched segment was 8%.

Conclusions

A combined policy of routine shunting and patching simplifies intraoperative decision making with results that rival or exceed those of trials in which their use was not standardized. Shunts need not be avoided because of concern of arterial injury.

Section snippets

Methods

The study was a retrospective review of a prospectively maintained database at an academic medical center. Intra- and postoperative data were evaluated for consecutive patients undergoing carotid endarterectomy during the period beginning in January 2000 and ending in June 2010. Basic demographic information and comorbidities were recorded. Operative data included shunt placement, the type of shunt used, whether difficulty was encountered with shunt placement, and the type of patch used for

Results

Over the selected time period, 220 procedures were performed: 43% for symptomatic disease (n = 95) and 57% for asymptomatic disease (n = 125). Shunt placement was attempted in 207 cases (94% of total carotid endarterectomy) and was successful in 202 (98% of those attempted). Sundt-type shunts (Integra Neurosciences, Plainsboro, NJ) were used in 72% of cases (n = 158) and Pruitt-Inahara (LeMaitre Vascular, Burlington, MA) in 19% (n = 42). In 1 case, the shunt type was not specified, and in

Comments

This series shows the safety and efficacy of routine carotid shunting with patch arteriotomy closure during carotid endarterectomy. The low incidence of perioperative stroke in our series despite the high proportion of symptomatic patients compared with most single-institution series suggests that carotid shunting combined with patch arteriotomy closure is an effective means to prevent harmful neurologic effects that result from a lack of cerebral perfusion. These data are in line with

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