Carotid artery reconstruction and routine use of intraluminal shunt

Complications of carotid artery reconstruction were reviewed in two groups of patients. In group A (213 patients, operation 1978-85) the surgical procedure varied according to intraoperatively measured back pressure in the internal carotid artery (ACI), with temporary intraluminal shunt when the ACI pressure was < 50 mmHg, but no shunt when the pressure was higher. In group B (339 patients, operation 1986-93), shunt was used in all cases. The incidence of complications was higher in group A than in group B (21.6% vs 13%). Temporary or permanent neurologic deficit occurred in 11.3% of the group A patients and in 5.6% of the group B patients. Routine use of temporary intraluminal shunt thus resulted in fewer complications of carotid artery surgery and allowed the surgeon to work undisturbed, a prerequisite for a successful outcome.