Design characteristics and clinical implementation of a newly designed indwelling carotid artery shunt

The author has developed a new silicone carotid artery shunt (Loftus carotid endarterectomy shunt, Integra NeuroCare, Plainsboro, New Jersey) which offers several advantages over previously available commercial products. It is designed as an indwelling 15 cm (short) shunt, without an external loop. The silicone material makes for simple insertion and the ends are beveled and tapered to minimize dislodgement of any atheromatous material. At its proximal end a built-up bulb has been placed to facilitate securing by a Rummel tourniquet. At the distal end of the shunt no bulb is necessary. A broad black band has been applied to its center to allow for immediate visual inspection of shunt migration or misplacement. In contrast to previous designs, no metal reinforcement is necessary in this shunt. It is supplied in two sizes in a kit which also includes a pair of disposable scissors hooked on the end for easy shunt transection at the time of removal. The shunt is best accompanied by a specialized shunt clamp (Loftus shunt clamp, Scanlan Medical Instruments, St. Paul, Minnesota) which has been designed with atraumatic jaws to secure it with minimal closing force in the internal carotid artery and to prevent back-bleeding around it. Clinical experience with the shunt has been extensive and satisfactory. Both the shunt kit and the shunt clamps are now available for commercial distribution.