The use of shunts in patients undergoing bilateral carotid endarterectomies. Help or hindrance.

A retrospective study was undertaken to help assess the influence of shunting or nonshunting in the performance of bilateral, staged carotid endarterectomies. During the years 1969 to 1979, 323 consecutive patients underwent 646 staged, bilateral carotid endarterectomies. The indications included 271 patients (83.5%) with hemispheric and nonhemispheric findings and 52 patients (16.5%) who were asymptomatic. Thirty-six patients had sustained a previous stroke. General endotracheal anesthesia and systemic heparinization were used in all operations. An indwelling shunt was used in 485 (75.1%) endarterectomies whereas 161 operations (24.9%) were done without a shunt, reflecting the surgeons' routine preferences rather than specific criteria of selection. There were 30 (4.6%) neurologic events in 29 patients. Five patients died, representing an operative mortality of 1.5 per cent. Neither carotid occlusion time, interval between operation, nor severity of extracranial occlusive disease correlated significantly with the occurrence of postoperative stroke. An analysis of the neurologic deficits revealed 27 in the shunted group (5.5%) and three in the nonshunted group (1.8%). Results of this study showed that shunting cannot be relied upon to decrease the risk of neurologic deficit and that superior results may be obtained without an indwelling shunt in performing carotid endarterectomy.