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Carotid endarterectomy: neither shunting nor patching technique
Aram Baram1, Goran Majeed2, Allaa Subhi Abdel-Majeed2
11 Department of Thoracic and Cardiovascular Surgery, Sulaimani Teaching Hospital, Sulaymaniyah, Iraq.
Asian Cardiovascular & Thoracic Annals
|July 15, 2018
Summary
Carotid endarterectomy without shunting is safe and effective for symptomatic patients with carotid artery stenosis. This non-shunting technique with primary closure shows comparable outcomes to shunting methods, with low complication and restenosis rates.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiovascular Medicine
Background:
- The necessity of carotid shunting during carotid endarterectomy remains debated.
- Studies show conflicting results regarding the benefits of patch angioplasty versus primary closure.
Purpose of the Study:
- To evaluate the safety and efficacy of carotid endarterectomy using a non-shunting technique with primary closure.
- To report early and late outcomes of this approach in symptomatic patients.
Main Methods:
- A series of 63 patients with symptomatic carotid artery stenosis underwent endarterectomy without shunting.
- Arteriotomies were closed primarily in all cases.
- Outcomes were analyzed with a minimum follow-up of 18 months.
Main Results:
- The most common comorbidity was diabetes.
- Postoperative complications included ischemic stroke (3.2%), hypoglossal nerve injury (1.6%), and cervical hematoma (1.6%).
- One patient (1.6%) developed asymptomatic carotid artery occlusion at 18 months.
Conclusions:
- Carotid endarterectomy without shunting and with primary closure is a safe procedure.
- Short- and long-term outcomes are comparable to shunting techniques.
- The restenosis rate is not higher than with patch angioplasty.
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