Results of carotid endarterectomy with the use of temporary shunts with reduced retrograde pressure in the internal carotid artery - analysis of the multicenter Russian register

Anton Kazantsev; Alexander Korotkikh; Roman Lider; Oleg Lebedev; Alexey Sirotkin; Petr Palagin; Otabek Mukhtorov; Dmitriy Shmatov; Sergey Artyukhov; Ivan Ageev; Alexandra Rogova; Ivan Kalichkin; Jasmine Beglaryan; Alla Snigur; Yuri Belov

doi:10.1007/s12055-023-01487-7

Results of carotid endarterectomy with the use of temporary shunts with reduced retrograde pressure in the internal carotid artery - analysis of the multicenter Russian register

Indian J Thorac Cardiovasc Surg. 2023 May;39(3):244-250. doi: 10.1007/s12055-023-01487-7. Epub 2023 Feb 21.

Authors

Affiliations

¹ Kostroma Regional Clinical Hospital Named After E.I. Korolev, Kostroma, Russian Federation.
² Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russia.
³ Kemerovo State Medical University of the Ministry of Health of the Russian Federation, Kemerovo, Russian Federation.
⁴ Clinic of High Medical Technologies Named After N.I. Pirogov St. Petersburg State University, Saint Petersburg, Russian Federation.
⁵ North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation.
⁶ Russian Scientific Center of Surgery named after Academician B.V. Petrovsky, Moscow, Russian Federation.

Abstract

Aim: The aim of the study was to assess the role of a temporary carotid shunt in patients undergoing carotid endarterectomy.

Materials and methods: This was a retrospective, multicentric (n = 159) study carried out between January 2005 and October 2020. The study included 3114 patients undergoing carotid endarterectomy who had a reduced retrograde internal carotid artery pressure (<60% of systolic blood pressure). A temporary carotid shunt was used in 1328 patients and 1786 patients underwent carotid endarterectomy without a shunt.

Results: The in-hospital outcomes were comparable in terms of the incidence of deaths, myocardial infarctions, and stroke between the two groups. However, asymptomatic strokes (confirmed on computed tomography) occurred more frequently in the group where the temporary shunt was used (34 (2.5%) vs. 10 (0.55%), p < 0.0001). The composite endpoints of adverse events were also higher in the group where a temporary shunt was used (44 (3.3%) vs. 28 (1.5%), p = 0.002). The risk of symptomatic stroke (both fatal and non-fatal) was higher in the group where a temporary shunt was not used, though this was statistically not significant. Logistic regression analysis identified diabetes mellitus and stenosis (81-90%) of the contralateral internal carotid artery to be important predictors for stroke.

Conclusion: Temporary carotid shunts during carotid endarterectomy were associated with increased rates of asymptomatic stroke. There were no statistically significant differences in the incidence of non-fatal or fatal stroke, myocardial infarction, and mortality.

Keywords: Carotid endarterectomy; Classical carotid endarterectomy; Contralateral stenosis; Refusal of a shunt; Retrograde pressure; Shunt.

© Indian Association of Cardiovascular-Thoracic Surgeons 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.