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December 1969

Carotid Artery Back Pressure: A Test of Cerebral Tolerance to Temporary Carotid Occlusion

Author Affiliations

San Francisco
From the Surgical Service, Veterans Administration Hospital, and the University of California School of Medicine, San Francisco.

Arch Surg. 1969;99(6):702-710. doi:10.1001/archsurg.1969.01340180026005

Temporary occlusion or bypass of the carotid artery is necessary in order to perform an endarterectomy of its bifurcation. Most patients tolerate temporary carotid occlusion easily. A few patients will develop signs of acute cerebrovascular insufficiency when the artery is clamped and require supplemental means of sustaining adequate cerebral circulation during endarterectomy. The selection and special management of patients who are intolerant of carotid occlusion are mandatory in order to reduce operative mortality and prevent neurological complications. Presently, the most reliable means of determining tolerance to carotid occlusion is to observe the patient's conscious response to carotid cross clamping while he is under local anesthesia. However, there are many advantages to performing carotid artery surgery with the patient under general anesthesia.1-4 If general anesthesia is to be used, the surgeon must develop a technique that will make all patients tolerant of temporary carotid occlusion, such as an internal shunt,

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