Optimal cutoff value of carotid stump pressure for determining the need for a carotid shunt in carotid artery endarterectomy

Objective This study was conducted to identify the diagnostic value of carotid stump pressure for determining the need for a carotid artery shunt in patients undergoing carotid artery endarterectomy. Materials and methods Carotid stump pressure was prospectively measured in all carotid artery endarterectomies performed under local anesthesia between January 2020 and April 2022. The shunt was selectively used when neurological symptoms appeared after carotid cross-clamping. Carotid stump pressure was compared between patients who needed shunting and those who did not. Demographic and clinical characteristics, hematological and biochemical parameters, and carotid stump pressure of the patients with and without shunts were statistically compared. To determine the optimal cutoff value and diagnostic performance of carotid stump pressure for identifying the patients who need a shunt, receiver operating characteristic analysis was performed. Results Overall, 102 patients (61 men and 41 women) who underwent carotid artery endarterectomy under local anesthesia were included, with an age range of 51-88 years. A carotid artery shunt was used in 16 (8 men and 8 women) patients. The carotid stump pressure values of the patients with a shunt were lower than those without a shunt (median (min-max): 42 (20-55) vs 51 (20-104), p < 0.0006). In the receiver operating characteristic curve analysis performed to determine the need for a shunt, the optimal cutoff value of carotid stump pressure was <= 48 mmHg, sensitivity was 93.8%, and specificity was 61.6% (area under the curve: 0.773, p < 0.0001). Conclusion Carotid stump pressure has sufficient diagnostic power to determine the need for a shunt, but it cannot be used alone in the clinical setting. Instead, it can be used in combination with other neurological monitoring methods.