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Carotid Endarterectomy:  The Unreliability of Intraoperative Monitoring in Patients Having Had Stroke or Reversible Ischemic Neurologic Deficit

David Rosenthal, MD; Paul E. Stanton Jr, MD; Pano A. Lamis, MD
Arch Surg. 1981;116(12):1569-1575. doi:10.1001/archsurg.1981.01380240053008.
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• We reviewed 125 patients who had had stroke or reversible ischemic neurologic deficits (RIND) and who underwent carotid endarterectomy, with follow-up extending to six years. Phase I patients (n = 36) had endarterectomy and shunt placement at operation by surgeons' preference. The rate of postoperative neurologic deficit was 8%. Phase II patients (n = 36) had endarterectomy monitored by EEG and stump pressures. Postoperative deficits occurred in 9%. The EEGs and stump pressures in these patients were "normal"; therefore, no shunt was used. Phase III patients (n = 41) had endarterectomy again monitored by EEG and stump pressure. Despite normal EEGs or stump pressures, all patients underwent endarterectomy with a temporary indwelling shunt. No complications occurred. In 368 patients operated on for transient ischemic attacks alone, the operative stroke rate was 1.6%. Stump pressure and EEG are unreliable indicators of cerebral perfusion during carotid endarterectomy in patients who have suffered stroke or RIND. Use of a temporary shunt is indicated in all of these patients.

(Arch Surg 1981;116:1569-1575)

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