Use of shunts with eversion carotid endarterectomy

Purpose: The purpose of this study was to examine the utility of carotid sh unting in the context of eversion endarterectomy. A comparison of patients who underwent carotid endarterectomy by eversion with and without shunts wa s performed. Methods: Over a 5-year period, 2724 eversion carotid endarterectomies were performed. In most of these operations patients were under cervical block a nesthesia. A shunt was used in 112 eversion endarterectomies (4.1%). Cervic al block anesthesia was used in 103 patients (92.0%), general anesthesia wa s used in 5 patients (4.5%), and 4 patients (3.6%) were converted from cerv ical block to general anesthesia intraoperatively. The indications for shun ting were neurologic deterioration in 99 patients (88.4%) who were under ce rvical block anesthesia, procedures performed in neurologically unstable or otherwise compromised patients who were under general anesthesia, and the operator's discretion in the remaining eight patients. Results: There was a combined stroke/death rate of 2.7% in the shunt group. These three cases included one death from myocardial infarction and one de layed death due to intracerebral hemorrhage after discharge. Shunt insertio n was unrelated to the negative outcome in these two cases. One perioperati ve major stroke in the shunt group was identified. Follow-up averaged 12.3 months (range, 1-53 months). Conclusion: Carotid shunts can be used effectively in the context of eversi on endarterectomy. Shunt insertion is not associated with an increased stro ke/death rate in these patients.