Original Research Article|Articles in Press

Comparing carotid endarterectomies with or without shunting in symptomatic and asymptomatic patients

Published:January 25, 2023DOI:


      • Carotid endarterectomies carry an associated risk depending on the extent of arterial occlusion.
      • Shunting can lead to additional postoperative complications such as stroke or cranial nerve injury (CNI).
      • Shunting was found to increase the risk of CNI in both symptomatic and asymptomatic patients.
      • Symptomatic patients who underwent CEA with shunting had an increased risk of neurological deficit, myocardial infarction, and urinary tract infection.



      Recent research shows that placement of an intraluminal shunt during a carotid endarterectomy (CEA) can be associated with postoperative complications. Therefore, we compared CEA operations with or without shunting to further analyze their clinical outcomes.


      From the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, 13,736 cases between 2016 and 2019 were analyzed to compare adult symptomatic and asymptomatic carotid stenosis patients who underwent a CEA operation, with or without shunt placement.


      Rates of stroke with a neurological deficit (p = 0.012), myocardial infarction (p = 0.021), and urinary tract infection (p = 0.030) were higher among symptomatic patients with shunting. Multivariate logistic regression revealed that risk of CNI was higher among both symptomatic (93.63%, p < 0.001) and asymptomatic (69.58%, p = 0.001) patients with shunting, irrespective of confounding variables.


      Shunting was found to be associated with higher rates of postoperative complications in both symptomatic and asymptomatic patient populations.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Easton J.D.
        History of carotid endarterectomy then and now.
        Stroke. 2014; 45: e101-e103
        • Bond R.
        • Rerkasem K.
        • Rothwell P.M.
        Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting).
        Cochrane Database Syst Rev. 2002; 2
        • Faateh M.
        • Dakour-Aridi H.
        • Kuo P.-L.
        • Locham S.
        • Rizwan M.
        • Malas M.B.
        Risk of emergent carotid endarterectomy varies by type of presenting symptoms.
        J Vasc Surg. 2019; 70: 130-137
        • Halsey J.H.
        Risks and benefits of shunting in carotid endarterectomy. The International Transcranial Doppler Collaborators.
        Stroke. 1992; 23: 1583-1587
        • Aburahma A.F.
        • Mousa A.Y.
        • Stone P.A.
        Shunting during carotid endarterectomy.
        J Vasc Surg. 2011; 54: 1502-1510
        • Baram A.
        • Majeed G.
        • Subhi Abdel-Majeed A.
        Carotid endarterectomy: neither shunting nor patching technique.
        Asian Cardiovasc Thorac Ann. 2018; 26: 446-450
        • Knappich C.
        • Kuehnl A.
        • Haller B.
        • et al.
        Associations of perioperative variables with the 30-day risk of stroke or death in carotid endarterectomy for symptomatic carotid stenosis.
        Stroke. 2019; 50: 3439-3448
        • Mendes G.A.C.
        • Zabramski J.M.
        • Elhadi A.M.
        • et al.
        Carotid endarterectomy: comparison of complications between transverse and longitudinal incision.
        Neurosurgery. 2014; 75: 110-116
        • Thirumala P.D.
        • Muralidharan A.
        • Loke Y.K.
        • Habeych M.
        • Crammond D.
        • Balzer J.
        Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy.
        J Clin Neurosci. 2016; 25: 27-35
        • Archie J.P.
        Technique and clinical results of carotid stump back-pressure to determine selective shunting during carotid endarterectomy.
        J Vasc Surg. 1991; 13: 319-327
        • Woodworth G.F.
        • McGirt M.J.
        • Than K.D.
        • Huang J.
        • Perler B.A.
        • Tamargo R.J.
        Selective versus routine intraoperative shunting during carotid endarterectomy: a multivariate outcome analysis.
        Neurosurgery. 2007; 61: 1170-1177