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Updated: May 5, 2026
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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
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3615 consecutive carotid endarterectomies without intraluminal shunt
A N Vachev1, N I Chernysheva1, O V Dmitriev1
1Samara State Medical University of the Ministry of Health of the Russian Federation, 443099, Samara, Russian Federation.
Summary
Carotid endarterectomy without a shunt is safe and effective for preventing stroke. Standardized perioperative management, including maintaining arterial pressure and monitoring brain blood flow, is crucial for successful outcomes in this procedure.
Area of Science:
- Vascular Surgery
- Neurology
- Anesthesiology
Background:
- Carotid endarterectomy is a common peripheral vascular surgery.
- This study analyzes 3615 patients undergoing carotid endarterectomy without an intraluminal arterial shunt.
Purpose of the Study:
- To evaluate the efficacy and safety of perioperative management and carotid endarterectomy without an intraluminal shunt.
- To assess the impact of this technique on stroke incidence.
Main Methods:
- A retrospective and prospective analysis of 3615 patients undergoing elective carotid endarterectomy without a shunt.
- Standardized perioperative management including elevated arterial pressure and cerebral oximetry monitoring.
- Comparison between modified (high divarication) and classical (autovenous plasty) endarterectomy techniques.
Main Results:
- The overall incidence of perioperative stroke was 1.36% (49/3615 patients).
- Atheroembolic stroke was the most common mechanism (1.13%), followed by hemodynamic (0.14%) and lacunar (0.08%).
- The mortality rate from ischemic stroke was 0.3% (11/3615 patients).
Conclusions:
- Carotid endarterectomy without an intraluminal shunt does not increase the risk of ischemic stroke.
- Effective management of cerebral hypoperfusion during carotid artery cross-clamping is an anesthesiological responsibility.
- This technique is a safe and effective alternative for selected patients.
