Selective Verus Routine Shunting in Carotid Endarterectomy Patients

• The primary objective of this investigation is to determine through a prospectively randomized method whether a SP >= 50 mm Hg can be used as a threshold to indicate the need for selective carotid shunting during CEA under GA. [ Time Frame: Within 30 days of enrollment ] [ Designated as safety issue: No ]
  

• A secondary objective is to document and measure the outcomes (death, minor stroke, major stroke, trans-ischemic attach (TIA)) that result from selective shunting. [ Time Frame: Within 30 days of enrollemnt ] [ Designated as safety issue: No ]
  

The significance extends to all surgeons who perform CEA because of their desire to improve patient care by decreasing the overall perioperative complication rate of the procedure by selectively not shunting those patients who ideally do not require it and thus eliminating the attendant morbidity associated with it.

The hypothesis is that there will be no difference in patient outcomes (death, minor strokes, major strokes, TIA) for patients undergoing a CEA with a SP of > 50 mm Hg using selective shunting.If the stump pressure is < 50 mm Hg the patient will receive standard of care (placement of a shunt) and excluded from the study.If the stump pressure is > 50 mm Hg the patient will be placed in the selective shunt arm and randomized to either have the CEA performed without the use of a shunt or with a shunt. All patients in the study, irrespective of treatment group will be followed post-operatively for 24 hours and 30 days. The patient will be monitored and the following outcomes documented - death, minor stroke, major stroke, trans-ischemic attack (TIA).