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Carotid Endarterectomy: To Shunt or Not to Shunt?

Carotid Endarterectomy: To Shunt or Not to Shunt? Abstract Carotid endarterectomy has been practiced as a method of reducing the risk of future stroke since 1956.1 Its logical appeal is such that it is now the most commonly performed vascular procedure other than aortocoronary bypass and, at more than 80,000 operations per year, the third most commonly performed surgical procedure in the United States.2 Recently, editorial concern regarding the status of carotid endarterectomy has been expressed because of evidence that the morbidity and mortality attributable to the procedure may be as high as 10%.2,3 Much better results are certainly possible and have been reported routinely in the literature for at least one decade.4-12 The surgeon's obligation is to reduce perioperative risk to an absolute minimum by a combination of judicious patient selection and refined operative technique. If the perioperative risk can be reduced to nearly zero, many of the concerns regarding the procedure would References 1. Cooley DA, Al-Naaman YD, Carton CA: Surgical treatment of arteriosclerotic occlusion of common carotid artery . J Neurosurg 1956;13:500-506.Crossref 2. Barnett HJM, Plum F, Walton JW: Carotid endarterectomy: An expression of concern . Stroke 1984;15:941-943.Crossref 3. Dyken ML, Pokras R: The performance of endarterectomy for disease of the extracranial arteries of the head . Stroke 1984;15:948-950.Crossref 4. Thompson JE: Complications of endarterectomy and their prevention . World J Surg 1979;3:155-165.Crossref 5. Giannotta SL, Dicks RE, Kindt GW: Carotid endarterectomy: Technical improvements . Neurosurgery 1980;7:309-312.Crossref 6. Crowell RM, Ojemann RG: Results and complications of carotid endarterectomy , in Smith RR (ed): Stroke and the Extracranial Vessels . New York, Raven Press, 1984, pp 203-212. 7. Sundt TM, Sharbrough FW, Piepgras DG, et al: Correlation of cerebral blood flow and encephalographic changes during carotid endarterectomy with results of surgery and hemodynamics of cerebral ischemia . Mayo Clin Proc 1981;56:533-543. 8. Baker WH, Dorner DB, Barnes RW: Carotid endarterectomy: Is an indwelling shunt necessary? Surgery 1977;82:321-326. 9. Whitney DG, Kahn EM, Estes JW, et al: Carotid artery surgery without a temporary indwelling shunt: One thousand nine hundred seventeen consecutive procedures . Arch Surg 1980;115:1393-1399.Crossref 10. Bland JE, Lazar ML: Carotid endarterectomy without a shunt . Neurosurgery 1981;8:153-157.Crossref 11. Allen GS, Preziosi TJ: Carotid endarterectomy: A prospective study of its efficacy and safety . Medicine 1981;60:298-309.Crossref 12. Ferguson GG, Blume WT, Farrar JK: Carotid endarterectomy: An evaluation of results in 282 consecutive cases in relationship to intraoperative monitoring, abstract No. 54. Program of the Annual Meeting of the American Association of Neurological Surgeons, Atlanta, April 23, 1985. 13. Ferguson GG: Intra-operative monitoring and internal shunts: Are they necessary in carotid endarterectomy? Stroke 1982;13:287-289.Crossref 14. Sundt TM Jr: The ischemic tolerance of neural tissue and the need for monitoring and selective shunting during carotid endarterectomy . Stroke 1983;14:93-98.Crossref 15. Ferguson GG: Letter to the editor . Stroke 1983;14:116-117. 16. Ferguson GG, Gamache FW Jr: Cerebral protection during carotid endarterectomy: Intraoperative monitoring, anesthetic techniques, and temporary shunts , in Smith RR (ed): Stroke and the Extracranial Vessels . New York, Raven Press, 1984, pp 187-201. 17. Ferguson GG: Extracranial carotid artery surgery . Clin Neurosurg 1982;29:543-574. 18. Markand ON, Dilley RS, Moorthy SS, et al: Monitoring of somatosensory evoked responses during carotid endarterectomy . Arch Neurol 1984;41:375-378.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Carotid Endarterectomy: To Shunt or Not to Shunt?

Ferguson, Gary G.
Archives of Neurology , Volume 43 (6) – Jun 1, 1986
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References (17)

Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1986.00520060075022
Publisher site
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Abstract

Abstract Carotid endarterectomy has been practiced as a method of reducing the risk of future stroke since 1956.1 Its logical appeal is such that it is now the most commonly performed vascular procedure other than aortocoronary bypass and, at more than 80,000 operations per year, the third most commonly performed surgical procedure in the United States.2 Recently, editorial concern regarding the status of carotid endarterectomy has been expressed because of evidence that the morbidity and mortality attributable to the procedure may be as high as 10%.2,3 Much better results are certainly possible and have been reported routinely in the literature for at least one decade.4-12 The surgeon's obligation is to reduce perioperative risk to an absolute minimum by a combination of judicious patient selection and refined operative technique. If the perioperative risk can be reduced to nearly zero, many of the concerns regarding the procedure would References 1. Cooley DA, Al-Naaman YD, Carton CA: Surgical treatment of arteriosclerotic occlusion of common carotid artery . J Neurosurg 1956;13:500-506.Crossref 2. Barnett HJM, Plum F, Walton JW: Carotid endarterectomy: An expression of concern . Stroke 1984;15:941-943.Crossref 3. Dyken ML, Pokras R: The performance of endarterectomy for disease of the extracranial arteries of the head . Stroke 1984;15:948-950.Crossref 4. Thompson JE: Complications of endarterectomy and their prevention . World J Surg 1979;3:155-165.Crossref 5. Giannotta SL, Dicks RE, Kindt GW: Carotid endarterectomy: Technical improvements . Neurosurgery 1980;7:309-312.Crossref 6. Crowell RM, Ojemann RG: Results and complications of carotid endarterectomy , in Smith RR (ed): Stroke and the Extracranial Vessels . New York, Raven Press, 1984, pp 203-212. 7. Sundt TM, Sharbrough FW, Piepgras DG, et al: Correlation of cerebral blood flow and encephalographic changes during carotid endarterectomy with results of surgery and hemodynamics of cerebral ischemia . Mayo Clin Proc 1981;56:533-543. 8. Baker WH, Dorner DB, Barnes RW: Carotid endarterectomy: Is an indwelling shunt necessary? Surgery 1977;82:321-326. 9. Whitney DG, Kahn EM, Estes JW, et al: Carotid artery surgery without a temporary indwelling shunt: One thousand nine hundred seventeen consecutive procedures . Arch Surg 1980;115:1393-1399.Crossref 10. Bland JE, Lazar ML: Carotid endarterectomy without a shunt . Neurosurgery 1981;8:153-157.Crossref 11. Allen GS, Preziosi TJ: Carotid endarterectomy: A prospective study of its efficacy and safety . Medicine 1981;60:298-309.Crossref 12. Ferguson GG, Blume WT, Farrar JK: Carotid endarterectomy: An evaluation of results in 282 consecutive cases in relationship to intraoperative monitoring, abstract No. 54. Program of the Annual Meeting of the American Association of Neurological Surgeons, Atlanta, April 23, 1985. 13. Ferguson GG: Intra-operative monitoring and internal shunts: Are they necessary in carotid endarterectomy? Stroke 1982;13:287-289.Crossref 14. Sundt TM Jr: The ischemic tolerance of neural tissue and the need for monitoring and selective shunting during carotid endarterectomy . Stroke 1983;14:93-98.Crossref 15. Ferguson GG: Letter to the editor . Stroke 1983;14:116-117. 16. Ferguson GG, Gamache FW Jr: Cerebral protection during carotid endarterectomy: Intraoperative monitoring, anesthetic techniques, and temporary shunts , in Smith RR (ed): Stroke and the Extracranial Vessels . New York, Raven Press, 1984, pp 187-201. 17. Ferguson GG: Extracranial carotid artery surgery . Clin Neurosurg 1982;29:543-574. 18. Markand ON, Dilley RS, Moorthy SS, et al: Monitoring of somatosensory evoked responses during carotid endarterectomy . Arch Neurol 1984;41:375-378.Crossref

Journal

Archives of Neurology – American Medical Association

Published: Jun 1, 1986

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