title: Carotid endarterectomy using a "home-constructed" shunt for patients intolerant to cross-clamping.
abstract: OBJECTIVE
  There is a small minority of patients with occlusive carotid artery disease, who are at high-risk for general anesthesia because of their intolerance to carotid flow blockage, even if only for seconds, without neurologic deficit. Even <30 s of temporary clamping of the carotid arteries to deploy a shunt may prove eventful in this patient group. We define safe carotid endarterectomy after the insertion of a novel shunt that we made from simple medical equipment in this patient population.
  
  
  METHODS
  Among 65 patients who underwent carotid endarterectomy between March 2010 and December 2012, 5 (7.7 %; 3 men and 2 women; age range 56-77 years) could not tolerate carotid clamping. We used an alternative carotid shunt, made by us from simple equipment in our clinic, during surgery for these patients.
  
  
  RESULTS
  Two patients had bilateral lesions and the remainder had unilateral disease. The degree of stenosis ranged from 70 to 95 %. Temporary carotid clamping resulted in neurologic events, such as loss of consciousness in all and tremor in one, in <10 s (range, from immediately to 8 s after clamping). Full neurologic function was regained 15-30 s after releasing the clamps. All of the patients tolerated the procedures well with the support of our novel shunt. Shunt flow was adequate in all patients and no neurologic deterioration occurred after carotid clamping. The mean carotid clamp time was 28.11 ± 14.19 min. There was no mortality and all patients were followed up for a mean period of 9.3 ± 3.6 months, uneventfully.
  
  
  CONCLUSIONS
  An alternative, simple shunt, which is easily constructed in the operating room or clinic, using an angiocatheter, a three-way stopcock, and a serum line can provide adequate cerebral flow and permit safe carotid endarterectomy for those rare patients with carotid artery stenosis, who cannot tolerate even seconds of carotid occlusion.
authors.affiliation: Duzce Ataturk State Hospital, Duzce, Turkey, muratugurlucan@yahoo.com.
authors.forename: Murat
authors.initials: M
authors.lastname: Ugurlucan
authors.forename: Muslum Ercument
authors.initials: ME
authors.lastname: Filik
authors.forename: Ilker Murat
authors.initials: IM
authors.lastname: Caglar
authors.forename: Ertugrul
authors.initials: E
authors.lastname: Zencirci
authors.forename: Omer Ali
authors.initials: OA
authors.lastname: Sayin
authors.forename: Omer
authors.initials: O
authors.lastname: Aydiner
authors.forename: Yahya
authors.initials: Y
authors.lastname: Yildiz
authors.forename: Murat
authors.initials: M
authors.lastname: Basaran
authors.forename: Sertac
authors.initials: S
authors.lastname: Cicek
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery*; D000075202:Contraindications; D016894:Endarterectomy, Carotid / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013525:Surgical Instruments; D062666:Vascular Access Devices
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