title: Selective shunt during carotid endarterectomy using routine awake test with respect to a lower shunt rate.
abstract: OBJECTIVE
  To evaluate shunt rate and discuss the resultsrelated to selective shunt placement during carotid endarterectomy (CEA) using routine awake test.
  
  
  METHODS
  Patients with CEA from 2007 to 2011 were retrospectively reviewed from prospectively collected data. The need for shunt placement was determined by the awake test, based on the alteration in the neurologic examination. We collected data by using the clinical records and imaging studies, and investigated factors related to selective shunt such as collateral circulation and contralateral internal carotid artery (ICA) stenosis.
  
  
  RESULTS
  There were 45 CEAs under regional anesthesia with the awake test in 44 patients. The mean age was 61.8 ± 7.1 years old. There were 82.2% (37/45) of males, and 68.9% (31/45) of symptomatic patients. Selective shunt placement had been performed in only two (4.4%) patients. Among them fewer cases (4%) had severe (stenosis >70%) contralateral ICA lesions, and more cases (91%) of complete morphology of the anterior or posterior circulation in the circle of Willis. There was no perioperative stroke, myocardial infarctionor death, and asymptomatic new brain lesions were detected in 4 patients (9%), including 2 cases of selective shunt placement.
  
  
  CONCLUSIONS
  CEA under routine awake test could besafe and feasible method with low shunt placement rate in selected patients.
authors.affiliation: Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Jayun
authors.initials: J
authors.lastname: Cho
authors.forename: Kyung Keun
authors.initials: KK
authors.lastname: Lee
authors.forename: Woo-Sung
authors.initials: WS
authors.lastname: Yun
authors.forename: Hyung-Kee
authors.initials: HK
authors.lastname: Kim
authors.forename: Yang-Ha
authors.initials: YH
authors.lastname: Hwang
authors.forename: Seung
authors.initials: S
authors.lastname: Huh
keywords: Brain ischemia; Carotid endarterectomy; Intraoperative monitoring; Prevention