Abstract
Single-center review of patients who underwent carotid endarterectomy (CEA) between September 2008 and July 2010. The authors performed 118 consecutive eversion CEAs under local anesthesia for symptomatic (66%; n = 78) and asymptomatic (34%; n = 40) carotid stenosis. Selective shunting was performed only for patients who developed neurologic changes after carotid clamping, regardless of stump pressure (SP) and was required in 10% (12) of cases. The mean SP in shunted patients was 23 mm Hg and was < 31 mm Hg in all 12 patients. Shunting was required in 50% (4/8) of patients with contralateral occlusion, who had significantly lower mean SP. Shunting was three times more likely in patients with preop stroke (21%; 8/38) vs those without preop stroke (6%; 4/72). The results suggest that mean SP < 31 mm Hg is a reliable and safe threshold for determining the need for shunting during CEA under general anesthesia.
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