Intorduction: In performing carotid endarterectomy (CEA), indwelling shunt tube placement is necessary in some cases with poor collateral flow. Particularly, in patients with critical hemodynamic insufficiency like contralateral internal carotid artery (ICA) occlusion, shorter cross-clamping duration is preferable. Furthermore, in patients who have common carotid artery (CCA) ulceration, shunt placement can be dangerous because of the risk of embolic complication through the indwelling shunt tube. For such cases, we introduced extracorporeal circulation technique for cerebral perfusion during CEA.
Methods: In 309 consecutive CEA cases, 16 cases (5.2%) were performed CEA under extracorporeal circulation. Using roller pump, arterial blood was supplied from brachial or femoral artery to the distal portion of the cervical ICA. In cases with contralateral ICA occlusion, distal ICA cannulation was performed without any cross clamping by using Seldinger technique. Other cases with CCA ulceration, distal ICA cannulation was performed with conventional indwelling shunt tube insertion technique.
Results: In 6 cases with contralateral ICA occlusion and 9 cases with ipsilateral CCA ulceration concomitant with ICA stenosis, and in one case had both contralateral ICA occlusion and ipsilateral CCA ulceration, we successfully performed CEA under extracorporeal circulation. No ischemic event was observed in all the cases.
Conclusions: This extracorporeal circulation procedure is very useful in patients with carotid artery disease who have extremely poor collateral flow or have severe CCA lesions.