1983 Volume 23 Issue 3 Pages 198-202
The operative results from 35 cases of carotid endarterectomy using no internal shunt were analyzed. In all cases, 300-800 ml of 20% mannitol were used before and during surgical occlusion of the internal carotid artery. The average occlusion time was 34.5 minutes, and the longest was 59 minutes. The internal carotid stump pressure was measured in 19 cases. Thirteen cases showed 50 mmHg or below, and six cases were 25 mmHg or below. The operative mortality rate was 0%, but one patient showed a transient motor weakness which continued for two hours after the operation. Three patients died of heart disease during the follow-up period. There was a considerable relationship between the stump pressure and the presence of collateral circulation on preoperative angiography. The stump pressure of all cases without collateral circulation through the anterior and posterior communicating arteries was less than 38 mmHg. Judging from collateral circulation on preoperative angiography and stump pressure, it was concluded that carotid endarterectomy without internal shunt can be performed more safely with the adequate administration of 20% mannitol.
