Carotid endarterectomy with routine electroencephalography and selective shunting

Carotid endarterectomy requires some sort of cerebral protection in some patients. Available strategies include routine shunting, pharmacologic cerebral protection, or selective shunting. Selective shunting may be based on preoperative criteria or, more commonly, some intraoperative determinant of adequacy of cerebral perfusion. There are several commonly used methods, but electroencephalography is a sensitive marker for adequacy of cerebral perfusion and we have found it an excellent tool in our strategy of selective shunting. This article reviews the various approaches to cerebral protection during carotid endarterectomy with emphasis on our experience with electroencephalography.