Carotid endarterectomy without temporary intraluminal shunt. Study of 309 consecutive operations

A prospective study was undertaken to determine the efficacy of performing carotid endarterectomy without an intraluminal shunt. During a two-year period, 240 patients, ranging in age from 36 to 89 years, underwent 309 consecutive carotid endarterectomies. The indication for operation was transient ischemic attacks in 151 (63%) patients, asymptomatic carotid bruit in 67 (28%), and previous stroke in 22 (9%). Internal shunts were not used in any patients and all arteriotomies were patched with a preclotted knitted Dacron velor patch. Systemic heparinization was used during the procedure. The early postoperative mortality was 0.64% (2/309). Both deaths were caused by myocardial infarction. The incidence of stroke after operation was 1.29% (4/309). Neither carotid clamp time nor the presence of contralateral disease correlated with the occurrence of postoperative stroke. According to results of angiography, 22 patients had total occlusion of the contralateral internal carotid artery with satisfactory intracranial circulation. No postoperative strokes occurred in this subgroup. Results of this study revealed that equally good or superior results may be obtained without a temporary shunt in performing carotid endarterectomy.