Document Detail


Carotid endarterectomy: to shunt or not to shunt.
MedLine Citation:
PMID:  3201506     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Because of controversies in the cerebrovascular literature regarding the use of an intraluminal shunt in carotid endarterectomy, we report a randomized prospective study of 118 consecutive symptomatic patients receiving surgery within a single neurosurgical practice. Over 4 years, 138 carotid endarterectomies were performed in the 118 patients, 63 operations with intraluminal shunting and 75 without. Standard rationale for surgery included ipsilateral cerebral infarction in 38% of the operations and ipsilateral transient ischemic attacks in 36%. Unilateral angiographic stenosis of greater than 90% was seen in 58% of the operations; there were no ipsilateral occlusions. Surgery was performed under general anesthesia with barbiturate induction and mild blood pressure elevation. The 30-day complication rate included a mortality rate of 0.7% with a 5.1% incidence of postoperative neurologic deficit and a 1.4% rate of myocardial infarction. In the 24 hours after surgery there were no cerebral infarctions in the shunted group and six in the unshunted group. This 8% rate in the unshunted group compared with 0% in the shunted group was significant at p = 0.023 with a power of 0.95 by Fisher's exact test and chi 2 analysis. This suggests that in our neurosurgical practice (resident training program) the use of an intraluminal shunt during carotid endarterectomy significantly reduces the risk of intraoperative neurologic deficit without increasing the incidence of other complications.
Authors:
M K Gumerlock; E A Neuwelt
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  19     ISSN:  0039-2499     ISO Abbreviation:  Stroke     Publication Date:  1988 Dec 
Date Detail:
Created Date:  1989-01-13     Completed Date:  1989-01-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1485-90     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Oregon Health Sciences University, Portland.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Carotid Arteries / surgery*
Cerebrovascular Disorders / surgery
Endarterectomy*
Humans
Middle Aged
Nervous System Diseases / etiology
Postoperative Complications

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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