title: Use of shunts with eversion carotid endarterectomy.
abstract: OBJECTIVE
  The purpose of this study was to examine the utility of carotid shunting in the context of eversion endarterectomy. A comparison of patients who underwent carotid endarterectomy by eversion with and without shunts was performed.
  
  
  METHODS
  Over a 5-year period, 2724 eversion carotid endarterectomies were performed. In most of these operations patients were under cervical block anesthesia. A shunt was used in 112 eversion endarterectomies (4.1%). Cervical block anesthesia was used in 103 patients (92.0%), general anesthesia was used in 5 patients (4.5%), and 4 patients (3.6%) were converted from cervical block to general anesthesia intraoperatively. The indications for shunting were neurologic deterioration in 99 patients (88.4%) who were under cervical block anesthesia, procedures performed in neurologically unstable or otherwise compromised patients who were under general anesthesia, and the operator's discretion in the remaining eight patients.
  
  
  RESULTS
  There was a combined stroke/death rate of 2.7% in the shunt group. These three cases included one death from myocardial infarction and one delayed death due to intracerebral hemorrhage after discharge. Shunt insertion was unrelated to the negative outcome in these two cases. One perioperative major stroke in the shunt group was identified. Follow-up averaged 12.3 months (range, 1-53 months).
  
  
  CONCLUSIONS
  Carotid shunts can be used effectively in the context of eversion endarterectomy. Shunt insertion is not associated with an increased stroke/death rate in these patients.
authors.affiliation: Institute for Vascular Health and Disease, Albany Medical College, NY 12208, USA.
authors.forename: B B
authors.initials: BB
authors.lastname: Chang
authors.forename: R C
authors.initials: RC
authors.lastname: Darling
authors.forename: M
authors.initials: M
authors.lastname: Patel
authors.forename: S P
authors.initials: SP
authors.lastname: Roddy
authors.forename: P S
authors.initials: PS
authors.lastname: Paty
authors.forename: P B
authors.initials: PB
authors.lastname: Kreienberg
authors.forename: W E
authors.initials: WE
authors.lastname: Lloyd
authors.forename: D M
authors.initials: DM
authors.lastname: Shah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014654:Vascular Patency