Carotid endarterectomy (CEA) is an effective treatment for significant
carotid atherosclerosis. Perioperative
stroke, a devastating complication, may be partially circumvented by shunting. However, routine shunt use is not without complications and does not benefit every patient. Our study is designed to determine whether CEA under
general anesthesia, without cerebral monitoring, can be safely done with shunting only in the presence of poor internal carotid artery back-
bleeding or contralateral carotid occlusion or critical
stenosis. The medical records of 995 carotid operations were reviewed. A subset of 117 operations was performed on 112 patients using selective shunting. Data were analyzed and outcomes compared. For the selective shunt group, indications for redo operations (n=13) were recurrent asymptomatic high-grade
stenosis in 69% and
amaurosis fugax or
transient ischemic attack in 31%. Indications for primary CEA (n=104) were asymptomatic high-grade
stenosis in 59%,
amaurosis fugax or
transient ischemic attack in 36%, previous
stroke in 3%, and global
ischemia in 2%. A selective shunt was used in 29% of all symptomatic and 11% of all asymptomatic patients. No cerebral monitoring was used. There were no perioperative deaths and no permanent
cranial nerve injuries, and there was one
stroke (0.8%) from postoperative
carotid thrombosis in a shunted patient. The average
length of stay was 1.6 days for the non-shunt group and 2.2 days for the shunt group. The routine shunt group (n=878) had an overall
stroke rate of 0.7%, no permanent cranial nerve deficits, and a mean
hospital stay of 2.6 days. CEA under
general anesthesia with selective shunting can be performed safely without cerebral monitoring.