[Open thrombendarterectomy of the carotid arteries with routine intraluminal shunt implantation, a reliable method for decreasing the risk of apoplexy--results of 11 years experience with 546 consecutive elective interventions].

The operative removal of haemodynamical significant carotid artery stenosis by endarterectomy nowadays is one of the vascular surgical standard procedures. Purpose of the operation is prevention of ischemic strokes. For a long-term prognostic advantage the patient has to take the risk of perioperative mortality and morbidity. While efforts are being made to minimize this risk, the question of optimal surgical strategy has not yet finally been solved. Since 1982 in our hospital all carotid endarterectomies are carried out with routine insertion of an intraluminal shunt. The distal intima step of the internal carotid artery is secured by a running suture and closure of the longitudinal arteriotomy is accomplished by dacron patch plasty. In this manner 546 successive operations have been performed under general anaesthesia until 1993. Intra- and postoperative mortality was 0.9% with an ischemic cerebral infarction rate of 1.8%. According to the preoperative stage of cerebrovascular insufficiency the frequencies for mortality and perioperative ischemic stroke were 0.6% and 1.3% for CVI I, 0.4% and 0.7% for CVI II and 2.8% and 5.7% for CVI IV. Apart from perioperative mortality for patients with CVI IV, these complication rates are clearly below the suggested limits of the Ad hoc Committee on Carotid Surgery Standards by the Stroke Council of the American Heart Association. Routine use of a temporary, intraluminal shunt in carotid artery operations therefore can be considered as a safe measure, with complication rates still not underbid by those achieved with intraoperative cerebral monitoring and selective shunting.