• Tsutomu Hitotsumatsu, Ataru Nishimura, Keisuke Ido, Katsuya Ishido, and Osamu Ito.
• Department of Neurosurgery, Stroke and Neurological Center, Shin-Koga Hospital, Kurume, Japan. Electronic address: tommy@tenjinkai.or.jp.
• World Neurosurg. 2014 Jul 1;82(1-2):239.e5-8.

ObjectiveTo report a newly developed intraluminal triple-balloon shunt designed to preserve the blood flow of both the internal carotid artery (ICA) and the external carotid artery (ECA) during carotid endarterectomy in patients with a previous ipsilateral extracranial-intracranial bypass, in whom hemodynamic cerebral ischemia might be caused by cross-clamping at the ICA as well as the ECA.MethodsThe novel device consists of 3 silicone tubes equipped with balloons at each end. The design facilitates insertion proximally to the common carotid artery and distally to both the ICA and the ECA.ResultsThe new shunt tube was used in 3 patients, each of whom had previously undergone ipsilateral superficial temporal artery-middle cerebral artery bypass for proximal middle cerebral artery occlusion. The blood flow of the middle cerebral artery and anterior cerebral artery was supplied independently from the ECA via the bypass and from the ICA, respectively. There were no shunt-related complications.ConclusionsThis novel shunt device can be used safely and effectively in cases requiring preservation of the blood supply to both the ICA and the ECA during carotid endarterectomy.Copyright © 2014 Elsevier Inc. All rights reserved.

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