{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T09:22:28Z","timestamp":1791105748569,"version":"4.1.0"},"reference-count":15,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2001,8,1]],"date-time":"2001-08-01T00:00:00Z","timestamp":996624000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiovascular Surgery"],"published-print":{"date-parts":[[2001,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Patients with severe stenosis of an internal carotid artery with contralateral occlusion (ICO) are at an increased risk for stroke, and therefore surgical treatment is usually recommended. Carotid endarterectomy (CEA) under regional anesthesia enables constant monitoring of neurologic status and selective shunting in cases of clinically evident cerebral ischemia. In this study, we assess the selective use of shunts based solely on changes in neurological status in awake patients with ICO undergoing CEA as well as their complication rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      During 1996\u20131998, we studied intraoperative findings and results of CEA under regional anesthesia with clinical monitoring of neurological status in two groups: (1) patients with stenosis (&gt;70% by NASCET) and contralateral occlusion (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 50) and (2) patients with stenosis and no contralateral occlusion (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 94).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Shunt insertion was required in 42% of group 1, and 6% in group 2. All of the patients in group 1 requiring shunts had stump pressures &lt;50 torr. The average stump pressure of group 1 (40 torr) was significantly lower than that of group 2 (75 torr), and was also lower than that of patients with severe contralateral stenosis (35 patients, 76 torr). Perioperative stroke rates were identical in both groups (2.1%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Since ICO patients are at a high risk for brain ischemia during ICA clamping, they require shunt insertion frequently. Patients with no contralateral occlusion require shunting at a much lower rate \u2014 even in the presence of severe contralateral stenosis. Regional anesthesia allows for early detection of brain ischemia and therefore, the perioperative results in both groups are similar.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/096721090100900405","type":"journal-article","created":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T19:18:52Z","timestamp":1727119132000},"page":"334-338","source":"Crossref","is-referenced-by-count":7,"title":["Carotid Endarterectomy in Awake Patients with Contralateral Carotid Artery Occlusion"],"prefix":"10.1177","volume":"9","author":[{"given":"R.","family":"Karmeli","sequence":"first","affiliation":[{"name":"Vascular Surgery Department, Carmel Medical Center, Neurology Department, Bnai Zion Medical Center, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Lubezky","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Carmel Medical Center, Neurology Department, Bnai Zion Medical Center, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Halak","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Carmel Medical Center, Neurology Department, Bnai Zion Medical Center, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z.","family":"Loberman","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Carmel Medical Center, Neurology Department, Bnai Zion Medical Center, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Weller","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Carmel Medical Center, Neurology Department, Bnai Zion Medical Center, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Fajer","sequence":"additional","affiliation":[{"name":"Vascular Surgery Department, Carmel Medical Center, Neurology Department, Bnai Zion Medical Center, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2001,8]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/0741-5214(93)90270-V"},{"issue":"1","key":"e_1_2_1_3_2","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1177\/096721099600400114","article-title":"Carotid endarterectomy in patients with carotid occlusion: review of a 10-year experience","volume":"4","author":"Coyle K.A.","year":"1996","unstructured":"Coyle K.A., Smith R.B., Salam A.A., , Carotid endarterectomy in patients with carotid occlusion: review of a 10-year experience. 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European Journal of Vascular and Endovascular Surgery, 1995, 10, 16\u201322.","journal-title":"European Journal of Vascular and Endovascular Surgery"},{"key":"e_1_2_1_9_2","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/S0002-9610(05)81050-5","article-title":"Carotid endarterectomy with an occluded contralateral artery","volume":"166","author":"McCarthy W.J.","year":"1993","unstructured":"McCarthy W.J., Wang R., Pearce W.H., , Carotid endarterectomy with an occluded contralateral artery. American Journal of Surgery, 1993, 166, 168\u2013172.","journal-title":"American Journal of Surgery"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(99)80278-5"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(99)80275-X"},{"key":"e_1_2_1_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s100169900201"},{"key":"e_1_2_1_13_2","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S1078-5884(98)80154-8","article-title":"Duplex scanning and CT angiography in the diagnosis of carotid artery occlusion: a prospective study","volume":"16","author":"Lubezky N.","year":"1998","unstructured":"Lubezky N., Fajer S., Barmeir E., , Duplex scanning and CT angiography in the diagnosis of carotid artery occlusion: a prospective study. European Journal of Vascular and Endovascular Surgery, 1998, 16, 133\u2013136.","journal-title":"European Journal of Vascular and Endovascular Surgery"},{"key":"e_1_2_1_14_2","first-page":"673","article-title":"Awake patient monitoring to determine the need for shunting during carotid endarterectomy","volume":"114","author":"Benjamin M.E.","year":"1993","unstructured":"Benjamin M.E., Silva M.B.Jr, Watt C., , Awake patient monitoring to determine the need for shunting during carotid endarterectomy. Surgery, 1993, 114, 673\u2013681.","journal-title":"Surgery"},{"key":"e_1_2_1_15_2","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/S0741-5214(98)70363-5","article-title":"Incidence, timing, and causes of cerebral ischemia during carotid endarterectomy with regional anesthesia","volume":"27","author":"Lawrence P.F.","year":"1998","unstructured":"Lawrence P.F., Alves J.C., Jicha D., , Incidence, timing, and causes of cerebral ischemia during carotid endarterectomy with regional anesthesia. Journal of Vascular Surgery, 1998, 27, 329\u2013337.","journal-title":"Journal of Vascular Surgery"},{"key":"e_1_2_1_16_2","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1097\/00006123-199910000-00011","article-title":"Clinical outcomes for patients at high risk who underwent carotid endarterectomy with regional anesthesia","volume":"45","author":"Magnadottir H.B.","year":"1999","unstructured":"Magnadottir H.B., Lightdale N., Harbaugh R.E., Clinical outcomes for patients at high risk who underwent carotid endarterectomy with regional anesthesia. Neurosurgery, 1999, 45, 786\u2013792.","journal-title":"Neurosurgery"}],"container-title":["Cardiovascular Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/096721090100900405","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/096721090100900405","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T01:02:43Z","timestamp":1767661363000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/096721090100900405"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2001,8]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2001,8]]}},"alternative-id":["10.1177\/096721090100900405"],"URL":"https:\/\/doi.org\/10.1177\/096721090100900405","relation":{},"ISSN":["0967-2109"],"issn-type":[{"value":"0967-2109","type":"print"}],"subject":[],"published":{"date-parts":[[2001,8]]}}}