Risk Index for Predicting Shunt in Carotid Endarterectomy

Predictors of cross-clamp-induced intraoperative monitoring changes during carotid endarterectomy using both electroencephalography and somatosensory evoked potentials

“…Sex is an important and under-recognized risk factor for intraoperative IOM changes, and may also be associated with clamp-related changes specifically (though this did not quite reach statistical significance, p=0.08). While, female sex has previously been identified, little speculation has been made about the reason for this finding 25 . Possible explanations include smaller vasculature, more challenging anatomy, and even unique plaque characteristics 26 .…”

“…Contralateral ICA disease has been most consistently identified as a predictor of cerebral ischemia requiring shunt placement during CEA 5,25,34 . We have shown a direct association between severity of contralateral ICA disease and risk of ipsilateral shunt placement.…”

“…We believe this is the most appropriate way to use this data for the surgeon who practices selective shunting. Despite previous attempts to create risk indices for shunt or even the use of artificial neural networks, models have generally been more accurate in predicting the lack of a need for shunt than the need for shunt 25,39 . However, the lack of an accurate model may not be terribly important.…”

Combined Stump Pressure and Oximetry for Shunt Use During Carotid Endarterectomy

“…Cerebral ischemia as the result of carotid cross-clamping during CEA is a less common cause of stroke because most persons have sufficient collateral flow to sustain their cerebral hemisphere for as long as it takes to complete the procedure and restore flow. 10 When cross-clamp ischemia does occur, it is immediately apparent. Patients undergoing surgery under regional anesthesia become less responsive or agitated and develop contralateral weakness, which reverses with declamping.…”

Benefit of selective shunt use during carotid endarterectomy under regional anesthesia

“…11 Alterations of the hemodynamic stability and both hypertension and hypotension were also reported supporting a faster intervention approach. 12 Described factors predicting the need of shunt include female gender, age of 75 or older, 13 contralateral carotid occlusion, [13][14][15] moderate ipsilateral internal carotid artery (ICA) stenosis (50-69%), 14,15 symptomatic presentation, 14 arterial hypertension, 13 and shunting in the first CEA. 16 Despite these, the use of routine or selective shunt or no shunt is still controversial considering the current evidence.…”