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ORIGINAL ARTICLES  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2001 October;42(5):657-62

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Asymptomatic carotid stenosis: selective or routine use of intraluminal shunt

Grga A., Hebrang A., Brkljacic B., Hlevnjak D., Sarlija M.

From the Centre for Vascular Diseases and *Department of Radiology Merkur Clinical Hospital, Zagreb, Croatia


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Back­ground. To eval­uate the use of tem­po­rary intra­lu­minal ­shunt (IS) ­during oper­a­tions in our ­patients for asymp­to­matic ­carotid sten­osis (ACS) of the ­internal ­carotid ­artery (ICA).
­Methods. Com­pli­ca­tions of ICA endar­te­rec­tomy ­were ­reviewed in two ­groups of asymp­to­matic ­patients. In ­group A (144 ­patients, oper­a­tion 1972-1985) tem­po­rary IS was ­used in 43 ­patients ­with the intra­op­er­a­tively meas­ured ICA ­back pres­sure <50 mmHg. In ­group B (170 ­patients, oper­a­tion 1986-1998) ­shunt was ­used in all ­cases.
­Results. The inci­dence of neu­ro­logic def­icit was ­higher ia ­group A ­than in ­group B (5.6% vs 1.2%, p<0.05). ­Within ­group A, the inci­dence of neu­ro­logic def­icit was sig­nif­i­cantly ­higher in the sub­group ­with ­back pres­sure >50 mmHg, and ­thus ­without ­shunt, ­than in ­group B ­with rou­tine use of ­shunt (6.0% vs 1.2%, p<0.05). ­There ­were no dif­fer­ences in the inci­dence of ­shunt-­related com­pli­ca­tions ­between the ­groups (3.0% vs 4.0%, p>0.05). We had no mor­tality ­after oper­a­tions of asymp­to­matic ­patients.
Con­clu­sions. The rou­tine use of IS ­reduced the ­rate of intra­op­er­a­tive and ­early post­op­er­a­tive neu­ro­logic com­pli­ca­tions of asymp­to­matic ­carotid endar­te­rec­tomy, and it was not asso­ciated ­with a ­higher inci­dence of com­pli­ca­tions.

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