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