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June 1969

Surgery for Cerebrovascular Insufficiency (Stroke): With Special Emphasis on Carotid Endarterectomy.

Arch Neurol. 1969;20(6):675. doi:10.1001/archneur.1969.00480120121015

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In an era when the treatment of focal atherosclerotic plaques remains the domain of what Page calls "plumber surgeons," carotid arterial surgical techniques which result in extremely low complication rates deserve attention. Thompson's results are very good. In particular, he is unusually adept at the placement of internal shunts in carotid arteries. He feels that such shunts are basic to successful brain protection during surgery and that they eliminate the necessity for other complicated apparatus. In support of this he cites 40 patients with severe carotid stenosis opposite carotid occlusion. Using a shunt on the stenotic side he achieved flow restoration "without a single operative death or postoperative neurological deficit." In 300 consecutive operations on 228 patients with transient cerebral ischemia where internal shunts were routinely employed, there were three deaths (1.3%) and two severe neurological deficits (0.87%). Operation related deficit in all categories of cerebral vascular insufficiency was 2.9%.

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