Factors influencing morbidity of carotid endarterectomy without a shunt.

Abstract

A retrospective analysis of 156 unshunted carotid endarterectomies in 124 patients indicates that at least three factors may influence the surgeon to consider using an indwelling shunt. Contralateral internal carotid artery occlusion, prolonged cross-clamp time, and possibly stump pressures less than 25 mm Hg torr were associated with increased rate of permanent neurologic deficit. Selective shunting would not be based on stump pressures less than 50 mm Hg torr, previous ipsilateral stroke, or abnormal intraoperative electroencephalogram.