Perioperative Cerebral Ischemic Complications after Carotid Endarterectomy Without Shunting: A Series of 400 Consecutive CEA Evaluated by Intraoperative Monitoring and Post-operative Diffusion-weighted Imaging

The use of intraluminal shunting during carotid endarterectomy (CEA) remains controversial. From January 2001 to September 2010, 400 CEAs without shunting were performed under general anesthesia by 14 neurosurgeons (2 consultants, 12 trainees). We used electroencephalography (EEG) and somatosensory evoked potential (SEP) to monitor under selective burst suppression using barbiturate or propofol administration during cross-clamping. In 66 of the 400 CEAs (16.5%), intraoperative monitoring demonstrated abnormalities after cross-clamping. In 26 (6.5%) of the 400 CEAs, new areas of diffusion hyperintensity were identified postoperatively. Within 30 days, the combined mortality and morbidity (symptomatic ischemia) rate was 2.8%. Thirteen (3.3%) patients presented with TIA. CEA without shunting can be safely performed with EEG and SEP monitoring under induced hypertention and selective burst suppression.