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June 1986

Carotid Endarterectomy: To Shunt or Not to Shunt?

Author Affiliations

From the Department of Neurosurgery, Clinical Neurosurgical Sciences, Division of Neurosurgery, The University of Western Ontario, London.

Arch Neurol. 1986;43(6):615-617. doi:10.1001/archneur.1986.00520060075022

Carotid endarterectomy has been practiced as a method of reducing the risk of future stroke since 1956.1 Its logical appeal is such that it is now the most commonly performed vascular procedure other than aortocoronary bypass and, at more than 80,000 operations per year, the third most commonly performed surgical procedure in the United States.2 Recently, editorial concern regarding the status of carotid endarterectomy has been expressed because of evidence that the morbidity and mortality attributable to the procedure may be as high as 10%.2,3 Much better results are certainly possible and have been reported routinely in the literature for at least one decade.4-12

The surgeon's obligation is to reduce perioperative risk to an absolute minimum by a combination of judicious patient selection and refined operative technique. If the perioperative risk can be reduced to nearly zero, many of the concerns regarding the procedure would