Is Shunting Necessary in Patients with Contralateral Carotid Occlusion Undergoing Carotid Endarterectomy?

Patients with a contralateral carotid occlusion (CCO) have higher stroke and mortality rates when undergoing carotid endarterectomy (CEA). Various strategies to reduce the risk of stroke during CEA have been well studied, including choice of anaesthesia, shunt insertion, intra-operative monitoring, and arterial closure techniques. 1 Naylor R. Rantner B. Ancetti S. de Borst G.J. De Carlo M. Halliday A. et al. European Society for Vascular Surgery (ESVS): 2023 clinical practice guidelines on the management of atherosclerotic carotid and vertebral artery disease. Eur J Vasc Endovasc Surg. 2023; 65: 7-111 Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar However, controversy remains around routine shunting of the ipsilateral carotid artery in patients undergoing CEA to reduce clamp related ischaemic complications.