Korean J Thorac Cardiovasc Surg.  2012 Apr;45(2):95-100. 10.5090/kjtcs.2012.45.2.95.

Routine Shunting is Safe and Reliable for Cerebral Perfusion during Carotid Endarterectomy in Symptomatic Carotid Stenosis

• Kim TY
• Choi JB
• Kim KH
• Kim MH
• Shin BS
• Park HK

• KMID: 1433670
• DOI: http://doi.org/10.5090/kjtcs.2012.45.2.95

Abstract

BACKGROUND
The purpose of this report is to describe the perioperative outcomes of standard carotid endarterectomy (CEA) with general anesthesia, routine shunting, and tissue patching in symptomatic carotid stenoses.
MATERIALS AND METHODS
Between October 2007 and July 2011, 22 patients with symptomatic carotid stenosis (male/female, 19/3; mean age, 67.2+/-9.4 years) underwent a combined total of 23 CEAs using a standardized technique. The strict surgical protocol included general anesthesia and standard carotid bifurcation endarterectomy with routine shunting. The 8-French Pruitt-Inahara shunt was used in all the patients.
RESULTS
During the ischemic time, the shunts were inserted within 2.5 minutes, and 5 patients (22.7%) revealed ischemic cerebral signals (flat wave) in electroencephalographic monitoring but recovered soon after insertion of the shunt. The mean shunting time for CEA was 59.1+/-10.3 minutes. There was no perioperative mortality or even minor stroke. All patients woke up in the operating room or the operative care room before being moved to the ward. One patient had difficulty swallowing due to hypoglossal nerve palsy, but had completely recovered by 1 month postsurgery.
CONCLUSION
Routine shunting is suggested to be a safe and reliable method of brain perfusion and protection during CEA in symptomatic carotid stenoses.

Keyword

Carotid arteries; Endarterectomy; Surgical procedures, operative; Shunts

MeSH Terms

Anesthesia, General
Brain
Carotid Arteries
Carotid Stenosis
Deglutition
Endarterectomy
Endarterectomy, Carotid
Humans
Hypoglossal Nerve Diseases
Operating Rooms
Perfusion
Stroke
Surgical Procedures, Operative