{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T23:20:29Z","timestamp":1774048829792,"version":"3.50.1"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"25","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,12,22]]},"abstract":"\n BACKGROUND<\/jats:title>\n Intraoperative shunt use during carotid endarterectomy (CEA), although critical for cerebral protection, may cause internal carotid artery (ICA) dissection in approximately 0.5% of cases. Shunt-induced dissections represent a distinct pathophysiological mechanism, differing from surgical technique\u2013related dissection, and typically occur distal to the arteriotomy site due to trauma from shunt tips or balloon inflation.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors present 2 cases of ICA dissection occurring during CEA with shunt use, both successfully managed with emergency endovascular stent insertion. In both case, complete resolution was achieved, with modified Rankin Scale scores of 0. Case 1 involved a 70-year-old male with 95% right carotid stenosis who developed dissection extending 6 cm distal to the arteriotomy. Dual-stent carotid artery stent placement resulted in complete resolution. Case 2 involved an 80-year-old female who developed extensive 55-mm left internal carotid dissection, immediately treated with overlapping dual-stent placement. A literature review of 13 cases demonstrated favorable outcomes with recent endovascular management approaches.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Shunt-related dissection is a preventable complication requiring specific technical precautions, including ensuring symmetric balloon expansion, using a gentle insertion technique, and minimizing longitudinal movement. When dissection occurs, immediate endovascular stent placement may provide superior outcomes compared with conservative management, effectively preventing thromboembolic complications while achieving excellent functional recovery.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25697<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25697","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T11:59:54Z","timestamp":1769083194000},"source":"Crossref","is-referenced-by-count":1,"title":["Shunt-related internal carotid artery dissection during carotid endarterectomy: illustrative cases"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9446-787X","authenticated-orcid":true,"given":"Ikuo","family":"Yamamoto","sequence":"first","affiliation":[{"name":"School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tadashi","family":"Higuchi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery,Nippon Medical School, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koshiro","family":"Isayama","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery,Nippon Medical School, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumihiro","family":"Matano","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery,Nippon Medical School, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9858-6083","authenticated-orcid":true,"given":"Yohei","family":"Nounaka","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery,Nippon Medical School, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minoru","family":"Ideguchi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery,Nippon Medical School, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1820-2463","authenticated-orcid":true,"given":"Ryuta","family":"Nakae","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2497-5772","authenticated-orcid":true,"given":"Akio","family":"Morita","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery,Nippon Medical School, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9753-1873","authenticated-orcid":true,"given":"Yasuo","family":"Murai","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery,Nippon Medical School, Bunkyo-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"8","key":"bib1","series-title":"J Am Coll Cardiol","first-page":"2074","article-title":"Emergency stenting to treat neurological complications occurring after carotid endarterectomy","volume":"37","author":"Anzuini","year":"2001;","unstructured":"Anzuini ABriguori CRoubin GSEmergency stenting to treat neurological complications occurring after carotid endarterectomy. J Am Coll Cardiol. 2001;37(8):2074-2079."},{"issue":"1","key":"bib2","series-title":"J Endovasc Surg","first-page":"10","article-title":"Carotid endarterectomy: the gold standard","volume":"3","author":"Zarins","year":"1996","unstructured":"Zarins CK.Carotid endarterectomy: the gold standard. J Endovasc Surg. 1996;3(1):10-15."},{"issue":"4","key":"bib3","series-title":"Tex Heart Inst J","first-page":"359","article-title":"Proximal shunt dissection: a potential problem in carotid endarterectomy","volume":"12","author":"Calhoun","year":"1985","unstructured":"Calhoun TRKitten CM.Proximal shunt dissection: a potential problem in carotid endarterectomy. 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Surg Neurol Int. 2022;13:101."},{"issue":"5","key":"bib15","series-title":"Eur J Vasc Endovasc Surg","first-page":"399","article-title":"Middle cerebral artery blood velocity, embolisation, and neurological outcome during carotid endarterectomy: a prospective comparison of the Javid and the Pruitt-Inahara shunts","volume":"14","author":"Wilkinson","year":"1997","unstructured":"Wilkinson JMRochester JRSivaguru ACameron ICFisher RBeard JD.Middle cerebral artery blood velocity, embolisation, and neurological outcome during carotid endarterectomy: a prospective comparison of the Javid and the Pruitt-Inahara shunts. 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Int J Surg Case Rep. 2015;14:89-91."},{"issue":"6","key":"bib6","series-title":"Br J Neurosurg","first-page":"862","article-title":"Distal internal carotid artery dissection due to the carotid shunt during carotid endarterectomy","volume":"29","author":"Katsuno","year":"2015","unstructured":"Katsuno MTanikawa RHashimoto MMatsuno A.Distal internal carotid artery dissection due to the carotid shunt during carotid endarterectomy. Br J Neurosurg. 2015;29(6):862-864."},{"issue":"2","key":"bib7","series-title":"J Neuroendovasc Ther","first-page":"118","article-title":"Carotid artery stenting for carotid artery dissection after endarterectomy: case report","volume":"3","author":"Kokuzawa","year":"2009","unstructured":"Kokuzawa JKaku YYamashita KHatsuda NAndo T.Carotid artery stenting for carotid artery dissection after endarterectomy: case report. J Neuroendovasc Ther. 2009;3(2):118-123."},{"issue":"3","key":"bib8","series-title":"Neurosurgery","first-page":"441","article-title":"Distal cervical carotid dissection after carotid endarterectomy: a complication of indwelling shunt?","volume":"19","author":"Loftus","year":"1986","unstructured":"Loftus CMDyste GNReinarz SJHingtgen WL.Distal cervical carotid dissection after carotid endarterectomy: a complication of indwelling shunt? Neurosurgery. 1986;19(3):441-445."},{"issue":"1","key":"bib9","series-title":"Surg Cereb Stroke","first-page":"54","article-title":"Shunt-related stenosis of distal cervical internal carotid artery after carotid endarterectomy: two case reports","volume":"39","author":"Sasamori","year":"2011","unstructured":"Sasamori TMabuchi SMoriwaki TNiiya YAsano THoukin K.Shunt-related stenosis of distal cervical internal carotid artery after carotid endarterectomy: two case reports. Surg Cereb Stroke. 2011;39(1):54-57"},{"issue":"4","key":"bib10","series-title":"J Neuroendovascular Ther","first-page":"175","article-title":"A patient who underwent stenting for dissection that occurred during carotid endarterectomy","volume":"12","author":"Sogabe","year":"2017","unstructured":"Sogabe SMatsushita NSuzue AIzumidani T.A patient who underwent stenting for dissection that occurred during carotid endarterectomy. J Neuroendovascular Ther. 2017;12(4):175-180."},{"key":"bib11","series-title":"Surg Neurol Int","first-page":"109","article-title":"Emergent carotid artery stenting for cervical internal carotid artery injury during carotid endarterectomy: a case report","volume":"12","author":"Takahashi","year":"2021","unstructured":"Takahashi TIkeda GIgarashi HEmergent carotid artery stenting for cervical internal carotid artery injury during carotid endarterectomy: a case report. Surg Neurol Int. 2021;12:109."},{"key":"bib12","series-title":"Int J Vasc Med","first-page":"816937","article-title":"Distal cervical carotid artery dissection after carotid endarterectomy: a complication of indwelling shunt","volume":"2010","author":"Tamaki","year":"2010","unstructured":"Tamaki TYoji NSaito N.Distal cervical carotid artery dissection after carotid endarterectomy: a complication of indwelling shunt. Int J Vasc Med. 2010;2010:816937."},{"issue":"1","key":"bib13","series-title":"J Vasc Surg","first-page":"225","article-title":"A case of traumatic internal carotid artery aneurysm secondary to carotid shunting","volume":"51","author":"Troisi","year":"2010","unstructured":"Troisi NDorigo WPulli RPratesi C.A case of traumatic internal carotid artery aneurysm secondary to carotid shunting. J Vasc Surg. 2010;51(1):225-227."},{"key":"bib14","series-title":"Surg Neurol Int","first-page":"101","article-title":"Elongated styloid process as a possible cause of distal carotid artery dissection after carotid endarterectomy using indwelling shunt: a case report","volume":"13","author":"Suzuki","year":"2022","unstructured":"Suzuki TKimura THasegawa HElongated styloid process as a possible cause of distal carotid artery dissection after carotid endarterectomy using indwelling shunt: a case report. Surg Neurol Int. 2022;13:101."},{"issue":"5","key":"bib15","series-title":"Eur J Vasc Endovasc Surg","first-page":"399","article-title":"Middle cerebral artery blood velocity, embolisation, and neurological outcome during carotid endarterectomy: a prospective comparison of the Javid and the Pruitt-Inahara shunts","volume":"14","author":"Wilkinson","year":"1997","unstructured":"Wilkinson JMRochester JRSivaguru ACameron ICFisher RBeard JD.Middle cerebral artery blood velocity, embolisation, and neurological outcome during carotid endarterectomy: a prospective comparison of the Javid and the Pruitt-Inahara shunts. 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