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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2005 December;18(6):439-44
Symptomatic carotid stenosis: selective or routine use of intraluminal shunt
Grga A., Hebrang A., Vidjak V., Coce F., Brkljacic B.
Aim. To evaluate the selective and routine use of temporary intraluminal shunt (IS) based on the incidence of intraoperative and early postoperative neurologic complications of endarterectomy for symptomatic carotid stenosis (SCS) of the internal carotid artery (ICA).
Methods. Complications of endarterectomy were reviewed in two groups of patients operated on from 1976 through 2000 for symptomatic stenosis of the ICA. In group A (182 patients) selective IS was used. Of these 182 patients, in 55 patients with the ICA back pressure ¾50 mmHg an IS was used, and in 127 patients with the back pressure > 50 mm Hg no shunt was used. In group B (454 patients) an IS was used routinely with no measurement of back pressure.
Results. In group A with selective use of shunt, the ICA back pressure was ¾50 mmHg in a relatively high number of patients (55, 30.3%), and was indicative of insufficient cerebral collateral circulation. There were no statistically significant differences in the incidence of overall neurologic complications between the groups A and B (8.2% vs 4.6%, p>0.05). Within group A, there was no statistically significant difference in the incidence of neurologic deficit between the subgroup with back pressure >50 mmHg, and thus without shunt, and the subgroup with back pressure ¾ 50 mmHg, with use of shunt (9.4% vs 5.4%, p>0.05). There was a higher percentage of intraoperative neurologic complications in patients with permanent cerebrovascular accident and minor neurologic deficit compared with patients with transitory ischaemia in group A (13.9% vs 6.1%, p>0.05) and in group B (8.1% vs 3.9%, p>0.05), but this difference was not statistically significant. There was no difference either in the mortality rate (1.7% vs 1.3%, p>0.05), or in the incidence of surgical complications and shunt-related complications between groups A and B.
Conclusions. There was no statistically significant difference in the incidence of intraoperative and early postoperative neurolgic complications of endarterectomy for symptomatic carotid artery stenosis (SCS) between patients with selective use of shunt and those in whom shunt was used routinely.