Carotid Endarterectomy Without a Shunt

What constitutes the "correct" treatment for atherosclerotic occlusive disease affecting the carotid, vertebral, subclavian, and innominate arteries remains a controversial question. Various methods of therapy have been proposed, including vasodilators,¹anticoagulants,²,³and surgical correction.⁴⁻⁸Even the advocates of surgery are in disagreement as to whether a patient with an acute stroke should or should not be operated on,⁹,¹⁰and whether a completely occluded internal carotid artery should or should not be explored.¹¹,¹²Finally, there is disagreement as to the appropriate anesthetic technique⁴,⁵and the need for an intravascular shunt.⁴,¹³ In 1964, we reported¹⁴our experience with our first 100 patients having extracranial arterial disease treated surgically. Because of poor results with patients who had suffered completed strokes, and with patients having completely occluded internal carotid arteries, we concluded that endarterectomy should be considered in two groups of patients with significant carotid stenosis: