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Home > Vascular Annual Meeting > PP4. Routine Carotid Endarterectomy Without a Shunt...

PP4. Routine Carotid Endarterectomy Without a Shunt Even in the Presence of a Contralateral Occlusion: A Review of 2,027 Procedures

Russell H. Samson, David P. Showalter, Michael R. Lepore, Jr., Deepak G. Nair
Florida State University Medical School, Sarasota, FL

OBJECTIVES: Twenty-year prospective experience with routine non-shunting during carotid endarterectomy (CEA), even in the presence of a contralateral internal carotid artery occlusion, is reviewed.

METHODS: Carotid endarterectomy was performed under general anesthesia without a shunt in 2,027 consecutive CEA procedures in 1,780 patients: 733 procedures were performed on females and 1,294 on males with ages ranging from 37 to 97 years and a mean age of 73 years. Monitoring of cerebral blood flow and/or function was not utilized in any patient. Blood pressure was maintained above 130 mmHg pharmacologically. Heparin (7500U) and protamine reversal were uniformly used.

RESULTS: A contralateral occlusion was present in 127 CEAs. 1,344 CEAs were performed with a Dacron patch. Average cross clamp time was 18.5 minutes and 21 minutes for CEA without and with patches respectively (minimum 8 minutes and maximum 58 minutes). Average cross clamp time in the presence of a contralateral occlusion was 19.6 minutes. Overall, neurological complications occurred within thirty days in 33 (1.62%) patients (17 strokes [0.84%] and 16 transient ischemic attacks (TIAs) [0.79%]). There was only one stroke in a patient with a contralateral occlusion (0.79%). Immediate postoperative events, i.e. those that could be implicated as due to lack of a shunt, were rare (0.89%) (10 strokes [0.49%] and 8 TIAs, [0.39%]). There were 12 perioperative deaths (0.59%) 4 following a stroke (0.2%) and 7 (0.35%) due a cardiac event.

CONCLUSIONS: Carotid endarterectomy may be performed safely without a shunt even in the presence of a contralateral occlusion. Further, contralateral occlusion does not appear to add additional risk to CEA and should not be considered a high risk for endarterectomy

AUTHOR DISCLOSURES: R.H. Samson, None; D.P. Showalter, None; M.R. Lepore, None; D.G. Nair, None.