• Yoichiro Kawamura, Daisuke Maruyama, Yojiro Akagi, and Koji Iihara.
• Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: kawamura.yoichiro.114@m.kyushu-u.ac.jp.
• World Neurosurg. 2017 Oct 1; 106: 813-818.

BackgroundCarotid artery near occlusion is a critical degree of stenosis whereby blood flow is decreased and the distal cervical and intracranial internal carotid arteries (ICAs) are prone to collapse. Considering the diminished perfusion and risk of progression to total occlusion and periocclusive embolism, we performed carotid endarterectomy for carotid artery near occlusion.MethodsAccurate evaluation of tandem stenosis or patency of the poststenotic ICA in carotid artery near occlusion is often difficult preoperatively. Thus we performed carotid endarterectomy in a hybrid operating room where intraoperative digital subtraction angiography (DSA) and endovascular angioplasty or stenting for distal lesions can be performed if necessary. In addition, to evaluate the distal ICA intraoperatively, we used an intraluminal shunt for shunt angiography, with injection of contrast material through the shunt tube, as a replacement for conventional DSA. Furthermore, an intraluminal shunt held the collapsed lumen open and provided a scaffold for suturing, which prevented postoperative stenosis of the distal ICA.ConclusionThe present report is intended to underline the merits of intraluminal shunt as a replacement for conventional DSA and as a scaffold for suturing.Copyright © 2017 Elsevier Inc. All rights reserved.

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