Simple And No Plaque Touch Shunting In Patients Undergoing Carotid Endarterectomy And Requiring Shunt : The Jalalzai Technique

Background

During carotid endarterectomy, the application of traditional shunt techniques may

occasionally impede carotid artery surgery.To achieve this objective, a novel and

uncomplicated shunt method can be readily executed by inserting one arterial cannula into

the internal carotid artery distally to the clamp, and another into the common carotid artery

proximally to the clamp.

Methods

In 38 consecutive patients who need shunting during carotid endarterectomy operation;

prior to the application of clamps, the presence of plaques in both the common carotid

artery and the internal carotid artery was verified using gently palpation. Following the

placement of the cross, a 16-gauge or 14-gauge branule was inserted into the plaque-free

region of the internal carotid artery to measure the stump pressure. A second granule was

attached to the back of the initial granule using a short line and a 3-way stopcock. This

second granule was positioned near the cross clamp on the common carotid artery. With

this 3-way stopcock shunt, flow was provided from the main carotid artery to the internal

carotid artery simultaneously with stump pressure and systemic pressure

Results

The mortality rate was 0/38 in first 30 days of discharge from hospital. All patients were

monitored with Near Ifrared Sprectoscopy and stamp pressure was monitored during

operation. None of the patients had any cerebrovascular event post operation.

Conclusion

In addition to offering a bloodless surgical site, this straightforward approach can be utilized

for patients undergoing carotid endarterectomy who necessitate shunting during the

procedure. However, this procedure may provide difficulties in individuals with proximal

plaque and calcifications in the internal carotid artery.