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Is it necessary to use an intraluminal shunt in symptomatic patients with contralateral carotid artery stenosis?
Insights
Carotid endarterectomy in patients with contralateral carotid artery stenosis can be safely performed without a routine intraluminal shunt. This study found no significant difference in complication rates between shunted and non-shunted groups.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease Management
Background:
- Evaluating carotid endarterectomy (CEA) outcomes in symptomatic patients with contralateral carotid artery stenosis.
- Comparing CEA performed with and without an intraluminal shunt.
Purpose of the Study:
- To assess the safety and efficacy of CEA without a routine intraluminal shunt in patients with contralateral carotid artery stenosis.
- To determine if shunt use impacts postoperative neurologic complications.
Main Methods:
- Retrospective review of 144 CEA operations (Jan 2007-Dec 2012).
- Patients divided into two groups: Group 1 (n=70) with shunt, Group 2 (n=74) without shunt.
- Postoperative neurologic complications and bleeding complications were recorded.
Main Results:
- Temporary neurologic impairment occurred in 4.3% (Group 1) and 2.7% (Group 2), a non-significant difference (p=0.675).
- No patients required reoperation for excessive bleeding.
- Overall stroke/death rate was 0.7%.
Conclusions:
- CEA in symptomatic patients with contralateral carotid artery occlusion can be safely performed without the routine use of an intraluminal shunt.
- Further research is needed to establish precise indications for shunt use in specific patient subgroups.
Background:
We aimed to investigate our results of carotid endarterectomy operations in symptomatic patients operated by using an intraluminal shunt and without use of an intraluminal shunt in patients with contralateral carotid artery stenosis.
Methods:
We reviewed the results of 144 carotid endarterectomy operations in patients with contralateral carotid artery stenosis from January 2007 to December 2012. These patients were allocated in 2 groups. Group 1 (n = 70) consisted of the patients operated by using an intraluminal shunt and Group 2 (n = 74) consisted of the patients operated without use of an intraluminal shunt. Postoperative neurologic complications were recorded.
Results:
Temporary neurologic impairment developed in 3 (4.3%) patients postoperatively in group 1 and in 2 (2.7%) patients postoperatively in group 2. This difference was not statistically significant between groups (p = 0.675). None of the patients returned to operation theatre due to excessive bleeding postoperatively. The stroke/death rate was 0.7% in the study group.
Conclusions:
We conclude that carotid endarterectomy in symptomatic patients with contralateral occlusion can be performed safely without the systematic use of a shunt. However, it is not possible to define exact indications for use of a shunt as we have no information on the reason why some surgeons used a shunt.
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