Subtle Cerebral Damage after Shunting vs Non Shunting during Carotid Endarterectomy

ObjectiveTo compare the extent of subtle cerebral damage (SCD) in patients undergoing carotid endarterectomy with or without shunt placement.DesignProspective, randomised study.Patients and methodsWe assessed a consecutive series of 96 patients undergoing endarterectomy for severe unilateral left carotid stenosis who had been randomly assigned to receive a shunt (48) or not (48). Eligibility criteria included age up to 80 years and Mini-Mental State Examination score >24 points. Patients underwent neuropsychological testing before surgery. Serum concentrations of S100 protein, neuron-specific enolase (NSE) and interleukin-6 (IL-6) were measured intraoperatively before and after carotid clamping. Finally, each patient underwent neuropsychological testing 3 weeks after surgery.ResultsPatients with and without shunt had similar serum concentrations of S100 protein, NSE and IL-6 as well as similar neuropsychological test scores, all p > 0.05.ConclusionsThere was no difference in subtle cerebral damage between patients randomized to receive a shunt or not.