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CEA Shunt Requirement Rate — FRCA Final MCQ

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ModerateGeneral AnaesthesiaCEA Shunt Requirement RateFRCA Final

A 65-year-old man (ASA III) undergoes a carotid endarterectomy under cervical plexus block. The block is supplemented with local infiltration by the surgeon. During carotid artery clamping the patient becomes confused and develops contralateral arm weakness. The surgeon inserts a shunt and symptoms resolve. What percentage of patients require a shunt during carotid endarterectomy?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — 10-15%

Approximately 10-15% of patients undergoing carotid endarterectomy require a shunt to maintain cerebral perfusion during carotid cross-clamping. The advantage of regional anaesthesia is that neurological monitoring is performed directly (speech, motor function, consciousness) rather than relying on indirect measures (NIRS, EEG, stump pressure). Shunt insertion carries its own risks (embolisation, intimal dissection), so it should only be used when indicated by clinical signs of cerebral ischaemia. Selective shunting based on neurological monitoring is the standard approach.

Reference: NICE – 2019 – NG128 Stroke; RCOA – 2023 – Vascular anaesthesia