• Kazumichi Yoshida, Yoshitaka Kurosaki, Takeshi Funaki, Takayuki Kikuchi, Akira Ishii, Jun C Takahashi, Yasushi Takagi, Sen Yamagata, and Susumu Miyamoto.
• Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: kazuy@kuhp.kyoto-u.ac.jp.
• World Neurosurg. 2014 Jul 1;82(1-2):e229-34.

ObjectiveTo evaluate the efficacy of flow control of the internal carotid artery (ICA) by the clamping of the common carotid artery, external carotid artery, and superior thyroid artery during surgical ICA dissection to reduce ischemic complications after carotid endarterectomy (CEA).MethodsSixty-seven patients (59 men; age, 70.5 ± 6.2 years) who underwent CEA by the same surgeon were retrospectively studied. Both conventional CEA (n = 29) and flow-control CEA (n = 38) were performed with the patient under general anesthesia and with the use of somatosensory-evoked potential and near-infrared spectroscopy monitoring as a guide for selective shunting. The number of new postoperative infarcts was assessed with preoperative and postoperative diffusion-weighted images (DWIs) obtained within 3 days of surgery. In addition to surgical technique, the effects of the following factors on new infarcts also were examined: age, side of ICA stenosis, high-grade stenosis, symptoms, and application of shunting.ResultsNew postoperative DWI lesions were observed in 7 of 67 patients (10.4%), and none of them was symptomatic. With respect to operative technique, the incidence rate of DWI spots was significantly lower in the flow-control group (2.6%) than in the conventional group (20.7%), odds ratio: 0.069; 95% confidence interval: 0.006-0.779; P = 0.031). On multiple logistic regression analysis, age, side of ICA stenosis, high-grade stenosis, symptoms, and the use of internal shunting did not have significant effects on new postoperative DWI lesions, whereas technique did have an effect.ConclusionThe proximal flow-control technique for CEA helps avoid embolic complications during surgical ICA dissection.Copyright © 2014 Elsevier Inc. All rights reserved.

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