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Carotid cross-clamp cerebral ischaemia — FRCA Final MCQ

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ModerateCardiothoracic and Vascular AnaesthesiaCarotid cross-clamp cerebral ischaemiaFRCA Final

A 74-year-old man undergoes awake carotid endarterectomy under cervical plexus block. Three minutes after carotid cross-clamping he develops slurred speech and contralateral hand weakness, which resolve when the clamp is released. What is the most appropriate management?

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

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Correct answer: E — Insert a carotid shunt before re-clamping

A reversible neurological deficit during carotid cross-clamping indicates inadequate collateral cerebral perfusion. In awake carotid endarterectomy this is a direct indication for shunt insertion before re-clamping. Sedation may obscure monitoring and does not treat cerebral hypoperfusion. Heparin reversal could increase thrombotic risk during vascular clamping.

Reference: Vascular Anaesthesia Society carotid endarterectomy guidance; RCoA Final FRCA Syllabus 2026