title: Routine Shunting is Safe and Reliable for Cerebral Perfusion during Carotid Endarterectomy in Symptomatic Carotid Stenosis.
abstract: BACKGROUND
  The purpose of this report is to describe the perioperative outcomes of standard carotid endarterectomy (CEA) with general anesthesia, routine shunting, and tissue patching in symptomatic carotid stenoses.
  
  
  METHODS
  Between October 2007 and July 2011, 22 patients with symptomatic carotid stenosis (male/female, 19/3; mean age, 67.2±9.4 years) underwent a combined total of 23 CEAs using a standardized technique. The strict surgical protocol included general anesthesia and standard carotid bifurcation endarterectomy with routine shunting. The 8-French Pruitt-Inahara shunt was used in all the patients.
  
  
  RESULTS
  During the ischemic time, the shunts were inserted within 2.5 minutes, and 5 patients (22.7%) revealed ischemic cerebral signals (flat wave) in electroencephalographic monitoring but recovered soon after insertion of the shunt. The mean shunting time for CEA was 59.1±10.3 minutes. There was no perioperative mortality or even minor stroke. All patients woke up in the operating room or the operative care room before being moved to the ward. One patient had difficulty swallowing due to hypoglossal nerve palsy, but had completely recovered by 1 month postsurgery.
  
  
  CONCLUSIONS
  Routine shunting is suggested to be a safe and reliable method of brain perfusion and protection during CEA in symptomatic carotid stenoses.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Division of Neurology, Chonbuk National University Hospital, Chonbuk National University Medical School, Korea.
authors.forename: Tae Yun
authors.initials: TY
authors.lastname: Kim
authors.forename: Jong Bum
authors.initials: JB
authors.lastname: Choi
authors.forename: Kyung Hwa
authors.initials: KH
authors.lastname: Kim
authors.forename: Min Ho
authors.initials: MH
authors.lastname: Kim
authors.forename: Byoung-Soo
authors.initials: BS
authors.lastname: Shin
authors.forename: Hyun Kyu
authors.initials: HK
authors.lastname: Park