Abstract
The indications for the use of an internal carotid shunt during carotid endarterectomy vary from routine<sup>1</sup>to specially selected cases based on internal carotid back pressure and/or the existence of a neurological deficit prior to the operation.<sup>2,3</sup>At the San Francisco Veterans Administration Hospital, we currently recommend the use of an internal carotid shunt in both patients with an internal carotid artery back pressure less than 25 mm Hg and in patients with a neurological deficit prior to operation. We use a commercially made Javid-type shunt (1852 USCI DABIB7954). The manufacturer recommends that this shunt be gas sterilized (ethylene oxide). Because of both the recent unavailability of the shunt from the manufacturer and a considerable increase in patient load, we have steam autoclaved our shunts, since gas sterilization and airation require 72 hours. During a recent operation, in which an internal carotid shunt was used for a back
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