Key result
Carotid endarterectomy without shunting or EEG monitoring appears safe with ~1% one-month stroke rate.
Why the study?
Is carotid endarterectomy without an indwelling shunt or EEG monitoring safe in symptomatic patients with carotid stenosis?
Observational (n=222)
Is carotid endarterectomy without an indwelling shunt or EEG monitoring safe in symptomatic patients with carotid stenosis?
Carotid endarterectomy can be performed safely without an indwelling shunt or EEG monitoring, resulting in very low rates of perioperative stroke and mortality.
Supports selective shunt- and EEG-free CEA under general anesthesia with hypertension; leaves open need for randomized trials before broader adoption.
This series of 280 consecutive carotid endarterectomies was performed on 222 patients without an indwelling shunt or electroencephalograpic monitoring. Symptomatic patients with lateralized and nonlateralized transient ischemic attacks, ulcerated atherosclerotic plaques. One-third of the patients had severe bilateral stenosis or unilateral stenosis and contralateral occlusion. Adequate cerebral protection was provided during operation by general anesthesia and moderate hypertension. The carotid occlusion time averaged 10 minutes. There was no operative mortality within 30 days. There were no strokes during carotid occlusion and only three strokes (1.1%) within 1 month of operation. Follow-up data are available on 93% of the patients. Indwelling shunts, electroencephalographic monitoring, and carotid back pressure measurements are not necessary for the safe performance of carotid endarterectomy.
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Bland et al. (1981) conducted an observational in Carotid stenosis, transient ischemic attacks, ulcerated atherosclerotic plaques (n=222). Carotid endarterectomy without shunt or EEG monitoring was evaluated on Strokes within 1 month of operation. Carotid endarterectomy without an indwelling shunt or electroencephalographic monitoring was safe, with no operative mortality and a 1.1% stroke rate within 1 month.
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