title: Pre-operative methods to predict need for shunting during carotid endarterectomy.
abstract: OBJECTIVE
  To establish whether pre-operative investigations are able to predict cerebral tolerance to carotid cross clamping during carotid endarterectomy (CEA).
  
  
  METHODS
  A search of the MEDLINE database from 1950 to 2015 was made in combination with manual cross-referencing using the search strategy: ("carotid" [all fields] AND "endarterectomy" [all fields]) AND "preoperative" [all fields]) AND "clamping" [all fields]) AND ("MRA" [all fields] OR "MRI" [all fields] OR "CT" [all fields] OR "CTA" [all fields] OR "EEG" [all fields] OR "Doppler" [all fields] OR "angiography" [all fields]). A total of 20 studies were identified as eligible for inclusion.
  
  
  RESULTS
  3D Time of Flight MRA and acetazolomide stress SPECT imaging have been reported to have a negative predictive value of 96% and 94% respectively for the need for intraoperative shunting during carotid endarterectomy.
  
  
  CONCLUSIONS
  There is some evidence to suggest that pre-operative imaging investigations can reliably identify which patients undergoing CEA will not require carotid shunting for neurological protection. However, this evidence is limited and there is a need for more rigorous studies to be conducted.
authors.affiliation: Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK. Electronic address: usman.jaffer@doctors.org.uk.
authors.forename: Usman
authors.initials: U
authors.lastname: Jaffer
authors.affiliation: Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
authors.forename: Pasha
authors.initials: P
authors.lastname: Normahani
authors.affiliation: Department of Anesthesia, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK; The Association of Anesthetists of UK & Eire, UK.
authors.forename: William
authors.initials: W
authors.lastname: Harrop-Griffiths
authors.affiliation: Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Standfield
mesh_terms: D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D002941:Circle of Willis / Q000000981:diagnostic imaging; D003250:Constriction; D016894:Endarterectomy, Carotid; D006801:Humans; D018810:Magnetic Resonance Angiography; D011300:Preoperative Care / Q000379:methods; D017585:Ultrasonography, Doppler, Transcranial; D014656:Vascular Surgical Procedures
keywords: Carotid; Endarterectomy; Imaging; Preoperative; Shunting; Vascular