Shunting during carotid endarterectomy

Area of Science:

• Vascular Surgery
• Neurology
• Clinical Outcomes Research

Background:

• The necessity of shunting during carotid endarterectomy (CEA) remains debated among surgeons.
• Evidence exists for both routine shunting and no-shunt techniques, alongside selective shunting strategies.
• Selective shunting utilizes various monitoring methods like electroencephalogram (EEG) and transcranial Doppler (TCD).

Purpose of the Study:

• To review existing evidence on shunting, nonshunting, and selective shunting during CEA.
• To compare perioperative outcomes associated with different shunting strategies.

Main Methods:

• A comprehensive PubMed/MEDLINE search was performed for CEA studies published between January 1990 and December 2010.
• Studies analyzed perioperative outcomes of routine shunting, routine nonshunting, and selective shunting based on EEG, TCD, carotid stump pressure (SP), cervical block anesthesia (CBA), and somatosensory evoked potential (SSEP).

Main Results:

• Mean perioperative stroke rates were 1.4% for routine shunting and 2% for routine nonshunting.
• Selective shunting stroke rates varied: 1.6% (EEG), 4.8% (TCD), 1.6% (SP), 1.8% (SSEP), and 1.1% (CBA).
• Similar perioperative stroke and death rates were observed across methods.

Conclusions:

• Both routine and selective shunting strategies are associated with low stroke rates in CEA.
• The choice between routine and selective shunting should be based on surgeon preference and comfort.
• Both approaches are considered acceptable for managing patients undergoing CEA.