Surgical Outcome of the Non-Shunt Carotid Endarterectomy

Anusak Liengudom MD*, Wuttipong Tirakotai MD*, Chaiyapol Vuttiopas MD*

Affiliation : * Department of Neurosurgery, Prasat Neurological Institute, Bangkok, Thailand

Background and
Objective : Nearly 60 years after the advent of carotid endarterectomy (CEA), controversy continues regarding the necessity of an indwelling shunt during carotid reconstruction. Reasonable arguments have been made for monitoring-dependent shunting, and remarks can be made in favor of non-shunt procedure. Based on the results of several studies, most strokes after CEA are thromboembolic and result from technical failures e.g. residual plaque fragments, and stenosis during arterial repair. The objective of the present study is to present the details and results of CEA without an intraluminal shunt. Material and Method: A retrospective study was performed to determine the effi cacy of non-shunt CEA. During a four-year period, 25 patients, ranging from 49 to 81 years underwent 25 consecutive CEA.
Results : The clinical presentations were previous minor stroke in 12, reversible ischemic neurological defi cit in eight, and TIA in fi ve. There was no early post-operative mortality. Neither carotid clamp time nor the presence of contralateral disease correlated with the occurrence of post-operative stroke.
Conclusion : Although the authors’ experience may be limited in terms of numbers of patients, satisfactory results in carotid reconstruction could be obtained using safe performance of CEA without intraluminal shunt.

Keywords : Carotid stenosis, Minor stroke, Non-shunt carotid endarterectomy, Reversible ischemic neurological defi cit, Transient ischemic attack

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