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To Shunt or Not to Shunt?

Robert G. Ojemann, MD; Roberto C. Heros, MD

Arch Neurol. 1986;43(6):617-618.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Carotid endarterectomy is now the third most common operation performed in the United States.¹ Concerns have been raised about the lack of proper indications for surgery in many patients, the risks of angiography, the surgical morbidity and mortality across the United States, and the overuse of intraoperative monitoring and shunting.^1-3

The most generally accepted indication for carotid endarterectomy is the development of a transient ischemic attack in a patient who is subsequently found to have significant unilateral stenosis at or near the origin of the internal carotid artery (residual lumen diameter less than 2.0 mm, causing a hemodynamic change) or a deep ulceration. When the patient's medical condition is stable and the operation is done by an experienced team with the patient under general anesthesia, the risk of mortality is approximately 1% and the risk of stroke morbidity is less than 3%^3-7 When there is significant . . . [Full Text PDF of this Article]

Author Affiliations
From the Department of Surgery, Harvard Medical School, and Department of Neurosurgery, Massachusetts General Hospital, Boston.

Footnotes
Accepted for publication Oct 5, 1985.

Reprint requests to Massachusetts General Hospital, Boston, MA 02114 (Dr Ojemann).

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