No abstract

artery (ICA) direct reimplantation were performed under shunting. Before suture completion, the shunt was removed, the carotid crossclamped (second clamping) and then the suture secured. Primary endpoints were 30-days mortality and relevant neurologic complication rate (RNCR), defined as the combination of perioperative major and minor stroke. A logistic regression was performed to identify predictors of RNCR among clinical and procedural factors, including also time period (2010-2014 vs 2015-2018) and operator experience (number of CEA per year). Results: One-hundred-sixty-nine CEAs were performed for crescendo TIA (n¼141, 83.4%) or acute ischemic stroke (n¼28, 18.9%). Mean age was 73.9AE7.4 years and 117 (69.2%) were male; 32 patients (18.9%) had concomitant contralateral stenosis !70% and 12 patients (7.1%) had contralateral ICA chronic occlusion. Mean delay of surgery from last symptom was 3.7AE5.4 days (median 2 days, range 0-60 days) and urgent surgery (< 48 hours) was performed in 65 cases (38.4%). Mean duration of surgery was 96AE28 minutes; first and second clamping time were 3.7AE1.1 minutes and 2.4AE0.7 minutes respectively. Standard CEA was performed in 107 patients (63.3%) while 62 (36.6%) received eversion CEA. There were no perioperative deaths; perioperative RNCR was 1.8% (major stroke: n¼ 2, 1.1%; minor stroke: n¼ 1, 0.6%). The presence of ischemic cerebral lesion at the preoperative CT (OR 2.55, 95%CI 0.11-27.60; P¼.45), contralateral carotid stenosis/occlusion (OR 0.52, 95%CI 0-17.7; P¼.99), clamping time (OR 0.27, 95%CI 0.04-1.43; P¼.10), urgent setting (OR 0.17, 95%CI 0.05-1.29; P¼.08), as well as operator experience (OR 1.2, 95%CI 0.23-12.32; P¼.66) and time period (OR 2.46, 95%CI 0.02-NA; P¼.99) were not significantly associated to increased RNCR risk. Conclusion: Routine shunting with delayed insertion after plaque removal seems to be a safe and effective technique, that contributed to maintain a low RNCR in neurologically symptomatic patients independently from major clinical factors, operator, and time period. Standardization of the surgical technique may be mandatory to maintain results over time.