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Clinical Research
Available online 21 September 2023
Short-term outcomes after selective shunt during carotid endarterectomy: a propensity score matching analysis
Resultados a corto plazo después de shunting selectivo durante la endarterectomía carotídea con anestesia regional: un análisis de propensity score-matching
Juliana Pereira-Macedoa,b,
Corresponding author

Corresponding author.
, Luís Duarte-Gamasb,c, António Pereira-Nevesb,c,d, José José Paulo de Andraded,e, João Rocha-Nevesb,c,d
a Department of Surgery, Centro Hospitalar do Médio-Ave, Vila Nova de Famalicão, Portugal
b Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
c Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Portugal
d Department of Biomedicine – Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal
e Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
Received 14 March 2023. Accepted 28 July 2023
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Figures (1)
Tables (3)
Table 1. Demographics and characteristics of patients.
Table 2. Shunt-related surgical techniques and outcomes.
Table 3. All patients and subgroup analysis of perioperative adverse events.
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Introduction and objectives

Carotid cross-clamping during carotid endarterectomy might lead to intraoperative neurologic deficits, increasing stroke/death risk. If deficits are detected, carotid shunting has been recommended to reduce the risk of stroke. However, shunting may sustain a specific chance of embolic events and subsequently incurring harm. Current evidence is still questionable regarding its clear benefit. The aim is to determine whether a policy of selective shunt impacts the complication rate following an endarterectomy.

Material and methods

From January 2013 to May 2021, all patients undergoing carotid endarterectomy under regional anesthesia with intraoperative neurologic alteration were retrieved. Patients submitted to selective shunt were compared to a non-shunt group. A 1:1 propensity score matching (PSM) was performed. Differences between the groups and clinical outcomes were calculated, resorting to univariate analysis.


Ninety-eight patients were selected, from which 23 were operated on using a shunt. After PSM, 22 non-shunt patients were compared to 22 matched shunted patients. Concerning demographics and comorbidities, both groups were comparable to pre and post-PSM, except for chronic heart failure, which was more prevalent in shunted patients (26.1%, P=0.036) in pre-PSM analysis. Regarding 30-day stroke and score Clavien–Dindo ≥2, no significant association was found (P=0.730, P=0.635 and P=0.942, P=0.472, correspondingly, for pre and post-PSM).


In this cohort, resorting to shunting did not demonstrate an advantage regarding 30-day stroke or a Clavien–Dindo ≥ 2 rates. Nevertheless, additional more extensive studies are mandatory to achieve precise results concerning the accurate utility of carotid shunting in this subset of patients under regional anesthesia.

Carotid shunting
Selective shunt
Intraoperative neurologic deficits
Cerebral hypoperfusion
Carotid clamping
Regional anesthesia
Introducción y objetivos

El pinzamiento carotídeo durante la endarterectomía carotídea podría provocar déficits neurológicos intraoperatorios, lo que aumenta el riesgo de accidente cerebrovascular/muerte. Si se detectan déficits, se ha recomendado la derivación carotídea para reducir el riesgo de accidente cerebrovascular. Sin embargo, la derivación puede sostener una posibilidad específica de eventos embólicos y, posteriormente, provocar daños. La evidencia actual aún es cuestionable con respecto a su claro beneficio. El objetivo es determinar si una política de derivación selectiva afecta la tasa de complicaciones después de una endarterectomía.

Material y métodos

Desde enero de 2013 hasta mayo de 2021 se recuperaron todos los pacientes sometidos a endarterectomía carotídea bajo anestesia regional con alteración neurológica intraoperatoria. Los pacientes sometidos a derivación selectiva se compararon con un grupo sin derivación. Se realizó una coincidencia de puntuación de propensión (PSM) 1:1. Se calcularon las diferencias entre los grupos y los resultados clínicos recurriendo al análisis univariado.


Se seleccionaron 98 pacientes, de los cuales 23 fueron intervenidos mediante derivación. Después de la PSM, se compararon 22 pacientes sin derivación con 22 pacientes emparejados con derivación. Con respecto a la demografía y las comorbilidades, ambos grupos fueron comparables a los de antes y después de la PSM, excepto por la insuficiencia cardíaca crónica, que fue más prevalente en los pacientes con derivación (26,1 %, P=0,036) en el análisis previo a la PSM. En cuanto al accidente cerebrovascular a los 30 días y la puntuación de Clavien–Dindo ≥2, no se encontró asociación significativa (P=0,730, P=0,635 y P=0,942, P=0,472, correspondientemente, para pre y post-PSM).


En esta cohorte, recurrir a la derivación no demostró una ventaja con respecto a las tasas de ictus a los 30 días o Clavien–Dindo ≥ 2. Sin embargo, se requieren estudios adicionales más extensos para lograr resultados precisos sobre la utilidad precisa de la derivación carotídea en este subgrupo de pacientes bajo anestesia regional.

Palabras clave:
Derivación carotídea
Derivación selectiva
Déficits neurológicos intraoperatorios
Hipoperfusión cerebral
Pinzamiento carotídeo
Anestesia regional


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