title: Shunting during carotid endarterectomy.
abstract: BACKGROUND
  The use of shunting during carotid endarterectomy (CEA) is controversial. While some surgeons advocate routine shunting, others prefer selective shunting or no shunting. Several large series have documented excellent results of CEA with routine shunting or without shunts. Others reported similar results with selective shunting using transcranial Doppler (TCD), electroencephalogram (EEG) monitoring, carotid stump pressure (SP), cervical block anesthesia (CBA), and somatosensory evoked potential (SSEP). In this study, we review the available evidence supporting shunting, nonshunting, and selective shunting during CEA.
  
  
  METHODS
  An electronic PubMed/MEDLINE search was conducted to identify all published CEA studies between January 1990 and December 2010, that analyzed the perioperative outcome of routine shunting, routine nonshunting, routine versus selective shunting, selecting shunting versus avoiding a shunt, and selective shunting based on EEG, TCD, SP, CBA, and SSEP.
  
  
  RESULTS
  The mean reported perioperative stroke rate for CEAs with routine shunting was 1.4% and for routine nonshunt was 2%. Meanwhile, the mean perioperative stroke rates for selecting shunting were 1.6% using EEG, 4.8% using TCD, 1.6% using SP, 1.8% using SSEP, and 1.1% for CBA. Similar results were noted for perioperative stroke and death rates.
  
  
  CONCLUSIONS
  The use of routine shunting and selective shunting was associated with a low stroke rate. Both methods are acceptable, and the individual surgeon should select the method with which they are more comfortable.
authors: Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV 25304, USA. ali.aburahma@camc.org
authors: Ali F
authors: AF
authors: Aburahma
authors: Albeir Y
authors: AY
authors: Mousa
authors: Patrick A
authors: PA
authors: Stone
mesh_terms: D001795:Blood Pressure Determination; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D004569:Electroencephalography; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005073:Evoked Potentials, Somatosensory; D006439:Hemodynamics; D006801:Humans; D016343:Monitoring, Intraoperative; D010092:Oximetry; D018579:Patient Selection; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial