External carotid artery shunting during carotid endarterectomy: an alternative for cerebral protection?

Abstract

to assess the application of external carotid artery (ECA) shunting in cerebral protection during carotid endarterectomy (CEA). prospective study. the study comprised 137 consecutive patients who underwent CEA under locoregional anaesthesia. Transcranial Doppler was used to monitor the mean velocity of the middle cerebral artery (mv-MCA): (1) before carotid clamping; (2) after clamping both the common and external carotid arteries; (3) after clamping the internal carotid artery alone ("ECA test"). The decision to shunt was based on the occurrence of neurological deficit during carotid clamping. If the ECA test revealed mv-MCA approaching the pre-clamping values ECA shunting was used, whereas the remaining patients in need of a shunt had a standard internal carotid artery (ICA) shunt. shunting was necessary in 12/137 cases (9%). The ECA test indicated that in four cases - 3% of the whole series or 33% of the shunted cases. In these four patients ECA shunting reversed the neurological deficit, and CEA was successfully performed without any complications. ECA shunting could be considered as an alternative to standard ICA shunting. Suitable cases can be identified on the basis of the ECA test.