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An Unreliable Guide for Shunting During Carotid Endarterectomy

Jack H. M. Kwaan, MD; Gary J. Peterson, MD; John E. Connolly, MD

Arch Surg. 1980;115(9):1083-1085.

Abstract
• A correlative analysis was made between the neurological status of the awake patient and the internal carotid artery stump pressure in 125 consecutive patients undergoing carotid endarterectomy. There was no mortality in this series. Twenty-four patients lost consciousness immediately after carotid crossclamping, even though stump pressures were above 50 mm Hg in more than one third of the cases. The majority (80.8%) of the patients tolerated cross-clamping (stump pressures were between 20 and 90 mm Hg). This study demonstrated the variability of cerebral tolerance relative to absolute stump pressure guidelines, such as 25 or 50 mm Hg; reliance on these values to determine the need for intraoperative shunting could lead to stroke at operation. Our experience also showed that assessment of the awake but tranquil patient continues to be the safest and most reliable guide to selective shunting during carotid endarterectomy.

(Arch Surg 115:1083-1085, 1980)

Author Affiliations
From the Department of Surgery, University of California at Irvine, and the Veterans Administration Medical Center, Long Beach, Calif.

Footnotes
Accepted for publication April 2, 1980.

Read before the annual meeting of the Southern California Chapter of the American College of Surgeons, Rancho Mirage, Calif, Jan 19, 1980.

Reprint requests to Department of Surgery, Veterans Administration Medical Center, 5901 E Seventh St, Long Beach, CA 90822 (Dr Kwaan).

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ABSTRACT