Carotid endarterectomy without a temporary indwelling shunt: results and analysis of back pressure measurements.

A consecutive series of 342 carotid endarterectomies for cerebrovascular insufficiency without a temporary indwelling shunt is presented. The series is clinically analysed regarding the incidence of postoperative neurological deficits and mortality and statistically analysed concerning factors that may be reliable in identifying patients at risk. A transient neurological deficit occurred in five patients (1.5%) and a permanent deficit in six (1.7%). The mortality rate was 1.5% (five patients). The combined postoperative stroke and mortality rate was 2.6%. There was no statistical difference in the incidence of neurological deficits relative to operative indication (symptom-free 2.7%; transient ischaemic attack 1.4%; prior stroke 2.4%), and to the condition of the contralateral internal carotid artery (normal 1.4%; stenosis 2.9%; total occlusion 0%); nor between patients with internal carotid artery back pressure measurements > 50 mmHg (1.2%), 25-50 mmHg (2.0%) and < 25 mmHg (3.8%). In conclusion, carotid endarterectomy without a shunt is a safe procedure with a low combined perioperative stroke and mortality rate.