[Shunting during carotid endarterectomy prevents postoperative cerebral hyperperfusion syndrome].

ABSTRACT

OBJECTIVE: To assess if shunting during carotid endarterectomy (CEA) can lower the risk of postoperative cerebral hyperperfusion (CH) and cerebral hyperperfusion syndrome (CHS). METHODS: This study was a prospective non-randomized controlled trial which approved by human rights committee of our hospital. From August 2009 to August 2012, 180 eligible patients with carotid arterial stenosis who had indication for CEA entered our study. 146 patients were males and 34 patients were females. Their age range was 38 - 83 years. Average age was (66 ± 9) years. Cerebral blood flow changes were monitored through Transcranial Doppler routinely. There were 81 cases with shunting and 99 without shunting. We compared the rate of CH, CHS and other complications between two groups. RESULTS: No patient died or suffered hemorrhagic stroke. There were no significant difference in average operation time between two groups ((144 ± 25) min vs (139 ± 34) min, P > 0.05), but the clamping time of shunting group was significantly shorter than no shunting group ((4 ± 4) min vs (26 ± 14) min, P < 0.05). The rate of CH and CHS of shunting group is lower than no shunting group (7.4% vs 18.2%, P < 0.05; 3.7% vs 12.1%, P < 0.05). There were no differences in other complications between two groups. CONCLUSION: Shunting during CEA can lower the rate of CH and CHS by shortening the time of intraoperative cerebral ischemia, but didn't increase the rate of other complications. Using shunt may be an effective method of preventing CHS after CEA, especially for the high risk patients according to preoperative evaluation.