Carotid endarterectomy: neurologic complications as related to surgical techniques

Three hundred seventeen carotid endarterectomies performed on 240 consecutive patients in four Charleston hospitals were reviewed. The overall incidence of stroke was 10.7% and the mortality 3.2%. From these 317 operations a standardized series of 253 operations performed on neurologically stable patients was analyzed for neurologic complications as related to the use of an intra-operative shunt. Additional factors studied were length of time of carotid occlusion and degree of contralateral carotid stenosis. From the standardized series the incidence of stroke in 137 shunted cases was 9.5%, and in 116 non-shunted cases was 0.9%, a significant difference (p less than 0.01). Carotid artery occlusion times from 30 seconds to 12 minutes in the shunted group, and three minutes to 24 minutes in the non-shunted group had no relationship to the incidence of stroke. Significant contralateral carotid artery stenosis, present in 28/137 shunted cases and 30/116 non-shunted cases, had no predictive value in the development of a stroke. The use of an intra-operative shunt did not protect against stroke in these patients.