Proximal shunt dissection: a potential problem in carotid endarterectomy

The use of a shunt routinely, selectively, or not at all in performing carotid endarterectomy is a controversial and thus far unsettled dilemma. We have routinely used a shunt because it allows the operation to be done meticulously and without a sense of urgency. However, we recently encountered a case in which proximal subintimal dissection occurred secondary to shunt insertion, which resulted in a postoperative neurologic deficit. We present the case, with a discussion of the probable cause of dissection and its future prevention.