Intraoperative monitoring and use of the internal shunt during carotid endarterectomy.

Carotid endarterectomy can be an effective form of therapy in stroke prevention in patients with carotid artery disease. A perioperative stroke is not only a devastating complication but negates the beneficial effects of the procedure. Careful attention to detail will prevent embolization during carotid endarterectomy and thus avoid the most common cause of perioperative cerebral infarction. The maintenance of adequate cerebral perfusion during carotid endarterectomy can be provided with the use of a shunt during carotid cross-clamping. This is necessary in approximately 15% of patients. Different approaches to the use of a shunt during carotid endarterectomy are discussed with their merits and disadvantages. Assessment of the technical results prior to completion of the operation should be an integral part of the procedure. The available methods, with their inherent limitations, are briefly discussed.