Background?Controversy exists about the effect of contralateral carotid stenosis on the perioperative risks of carotid endarterectomy (CEA). Despite increased perioperative risk, the long-term outcome is improved in patients who undergo ipsilateral CEA with significant contralateral carotid stenosis. Traditionally, this involved shunting the ipsilateral carotid artery during the procedure. It was believed that this minimized the risk for cerebral ischemia. We believe selective shunting can be employed while still avoiding cerebral ischemia. This requires a reliable method of monitoring for ischemia. Intraoperative EEG monitoring has been proven to be a reliable method for monitoring for ischemic changes during a case. Methods?A standard operative technique involving continuous EEG monitoring was used. We reviewed the records of carotid endarterectomies in the past 3 years. We present a series of 8 cases of CEA with contralateral occlusion in which shunting was selective based on EEG. Results?Of eight patients, seven (87.5%) tolerated the procedure without EEG changes and thus did not requiring intraluminal shunting. There were no long-term complications in our series of patients. Conclusion?We found that intraluminal carotid shunting during CEA with contralateral occlusion is not mandatory but neuroprotection methods need to be added to the operative procedure to ensure safety.

Median age of patients was 78.5 years at the moment of therapy suspension. After a median follow-up of 93.9 months, fourteen patients (31.8%) showed progression of disease, but only 7 (15.9%) of these died. In 7 (15.9%) patients, serum testosterone levels did not exceed 0.5 ng/ml, indicating an absence of gonadal activity. The median time to progression was 138.2 months, and the median cumulative survival from the start and from the suspension of androgen-suppression therapy was 105.5 months and 64.1 months, respectively. The savings in drug costs amounted to 772,267 Euro. Taking into consideration these outcomes of survival and of savings in drug costs, we can conclude that in these selected elderly patients, this treatment option could be of interest.