Carotid endarterectomy without shunt.

This series of 280 consecutive carotid endarterectomies was performed on 222 patients without an indwelling shunt or electroencephalograpic monitoring. Symptomatic patients with lateralized and nonlateralized transient ischemic attacks, ulcerated atherosclerotic plaques. One-third of the patients had severe bilateral stenosis or unilateral stenosis and contralateral occlusion. Adequate cerebral protection was provided during operation by general anesthesia and moderate hypertension. The carotid occlusion time averaged 10 minutes. There was no operative mortality within 30 days. There were no strokes during carotid occlusion and only three strokes (1.1%) within 1 month of operation. Follow-up data are available on 93% of the patients. Indwelling shunts, electroencephalographic monitoring, and carotid back pressure measurements are not necessary for the safe performance of carotid endarterectomy.