Surgical Procedure and Results of Carotid Endarterectomy with Routine Shunt Placement

Abstract

Background: Carotid endarterectomy (CEA) carries the risk of cerebral ischemia due to cross-clamping; however, the use of a shunt can effectively avoid this. At our institute, CEA following a standardized shunt procedure is routinely performed. In this study, we describe the treatment methods and results.

Methods: From April 2013 to March 2020, we used a shunt in 186 patients who underwent CEA at our institute. Cerebral ischemia was evaluated using intraoperative somatosensory evoked potential (SEP), and by determining the presence of symptomatic cerebral infarction.

Results: Shunt placement was difficult in four cases (2.2%). The average clamping time to insert the shunt was 4.4 min, and the removal-reperfusion time was 7.3 min. Intraoperative SEP reduction was observed in 15 patients (8.1%); however, postoperative cerebral infarction occurred in only one patient (0.5%). No obvious complications due to shunt use were observed.

Conclusions: CEA with shunt placement following the standardized procedure is a safe and secure method for surgeons.