Fixative method of carotid shunt using a Sugita's fenestrated aneurysm clip as a device in carotid endarterectomy technical note

BACKGROUND: Difficulty for distal exposure of the ICA is sometimes encountered during CEA. A carotid shunt is used to maintain sufficient cerebral blood flow during CEA but requires fixative materials, such as a string or a metallic ring, which often restrict the operative field, especially that of the distal ICA. METHODS: Here, we describe a novel technique for carotid shunt fixation using a unique fixative device in CEA. In the method presented here, the carotid shunt is fixed with an inflated balloon and a conventional vascular tourniquet proximally, but distal fixation is achieved using a Sugita's fenestrated clip that catches the mid portion of the carotid shunt and surrounding tissue. RESULTS AND CONCLUSION: The device prevents the distal carotid shunt slipping out of the distal ICA. The present method allows mobilization of the shunt position during CEA and facilitates far-distal exposure of the ICA.