title: Results of routine shunting and patch closure during carotid endarterectomy.
abstract: BACKGROUND
  The role of shunting and patching during carotid endarterectomy remains controversial.
  
  
  METHODS
  This is a retrospective case series evaluating consecutive patients undergoing carotid endarterectomy with routine shunting and patching. The primary endpoints were perioperative stroke, arterial injury, and lesion recurrence by duplex.
  
  
  RESULTS
  Of the 220 operations performed, 43% were for symptomatic disease. Successful shunt placement occurred in 98%, with no shunt-related injuries. There was 1 minor perioperative stroke and no major strokes. At a mean follow-up of 24 months (median = 12 months), there was 1 restenosis potentially related to shunt placement. The incidence of asymptomatic >50% stenosis in the patched segment was 8%.
  
  
  CONCLUSIONS
  A combined policy of routine shunting and patching simplifies intraoperative decision making with results that rival or exceed those of trials in which their use was not standardized. Shunts need not be avoided because of concern of arterial injury.
authors.affiliation: Division of Vascular Surgery, OP-11, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Marcus R
authors.initials: MR
authors.lastname: Kret
authors.affiliation: Division of Vascular Surgery, OP-11, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Young
authors.affiliation: Division of Vascular Surgery, OP-11, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Moneta
authors.affiliation: Division of Vascular Surgery, OP-11, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Liem
authors.affiliation: Division of Vascular Surgery, OP-11, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Erica L
authors.initials: EL
authors.lastname: Mitchell
authors.affiliation: Division of Vascular Surgery, OP-11, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Amir F
authors.initials: AF
authors.lastname: Azarbal
authors.affiliation: Division of Vascular Surgery, OP-11, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. Electronic address: landryg@ohsu.edu.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Landry
mesh_terms: D001783:Blood Flow Velocity; D016893:Carotid Stenosis / Q000503:physiopathology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000517:prevention & control