Short-term outcomes after selective shunt during carotid endarterectomy: A propensity score matching analysis

Autores da FMUP

• João Manuel Palmeira Rocha Neves

  Autor

Participantes de fora da FMUP

• Pereira-Macedoa, J
• Duarte-Gamasb, LAF
• Pereira-Nevesb, AH
• de Andraded, JPAV

Unidades de investigação

• Biomedicina

Abstract

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. Results: 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).

Keywords

• Carotid shunting; Selective shunt; Intraoperative neurologic deficits; Cerebral hypoperfusion; Carotid clamping; Regional anesthesia