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June 1986

Shunting During Carotid Endarterectomy

Arch Neurol. 1986;43(6):618. doi:10.1001/archneur.1986.00520060078024

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Shunting during carotid endarterectomy is designed to maintain cerebral perfusion during cross clamping. In Dr Ferguson's series of 282 consecutive cases, 30% showed a significant and 12% showed a severe change on the electroencephalogram (EEG). The benefits of shunting must be weighed against the small risk of causing embolization or dissection with shunt insertion and the fact that most intraoperative strokes are embolic and not hemodynamic.

All contributors to this controversy agree that the majority of patients undergoing endarterectomy do not require a shunt. They also agree that patients should have EEG monitoring to identify those at high risk. The differences become more a question of position than of practice. Drs Ojemann and Heros advocate "reliable monitoring and selective shunting" while Dr Ferguson is now prepared to consider the hypothesis that a small subgroup of patients with severe EEG change and mean stump pressures of 25 mm Hg or less

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