Intraluminal Shunt in Carotid Endarterectomies Increases the Risk of Ischemic Stroke

Impact of different perioperative intraluminal shunt insertion methods on final patient outcomes after carotid endarterectomy in a sample of 250 patients

“…Published study results have clearly shown that intraluminal shunt insertion is associated with high perioperative morbidity. During surgery, the vessel wall can be damaged and central embolization with a greater number of ischemic lesions can occur [9][10][11][12]. The prolonged length of the surgery could also be associated with higher risk of neurological complications.…”

“…In such cases, use of an intraluminal shunt is a reasonable approach to minimize the risk of neurological defi cit. As a result, the majority of neurosurgery departments use intraluminal shunts selectively [9,10]; our department prefers the same method when carotid endarterectomies are performed. The question remains, however, of how to recognize patients for whom shunt insertion would be benefi cial in relation to perioperative morbidity.…”

“…Observations regarding perioperative morbidity were based on major studies conducted at the end of the previous century [19][20][21]. At present, most neurosurgery departments report improved results [6,9,10]. Previous observations of 6% mortality and morbidity in symptomatic patients and 3% mortality in asymptomatic patients are too high in relation to recently published results.…”

“…Intraoperative use of an intraluminal shunt may reduce the risk of stroke by reducing the compromise of cerebral blood fl ow. Unfortunately, shunt insertion itself is associated with signifi cant risk of atherosclerotic arterial wall damage and subsequent stroke during carotid endarterectomy [9][10][11]; even uncomplicated and early shunt insertions can lead to cerebral hypoperfusion and risk of new structural brain lesions [9,10].…”

“…Previously published studies have demonstrated the risks associated with shunt insertion [9][10][11][12]; thus, we modifi ed timing criteria of the procedure in relation to decreased SEP and evaluated a sample of patients for whom this modifi ed approach was utilized.…”