ABSTRACT
Once the shunt has been placed and secured in the CCA and has slid down satisfactorily, the DeBakey forceps that are holding the plastic tubing closed are released until the entire shunt lumen is filled with a solid column of blood and all air and debris have been evacuated from it. In this fashion, one can be certain that no atheroma dislodged from placement of the shunt remains in the lumen where it might inadvertently be sent up the ICA. The ability to evacuate any possible atheroma is the reason I place this shunt in the CCA first, and only when I am certain that there is no foreign material present do I place it in the ICA.
