EVERSION CAROTID ENDARTERECTOMY - A SAFE, ADVANTAGEOUS ALTERNATIVE TOCONVENTIONAL CAROTID ENDARTERECTOMY - A PRELIMINARY-REPORT

Objective: To compare the results and time and cost efficacy of eversi on carotid endarterectomy (ECEA) with standard carotid endarterectomy (SCEA). Methods: A retrospective analysis of 88 carotid endarterectomi es performed by the residents under the guidance of the senior author between January 1, 1991, and December 31, 1993, was done. Fifty-five p atients underwent SCEA (44 vein patch, 11 primary closure) and 33 had ECEA. The two groups were compared for operative time, intraoperative evaluation, cost, immediate and delayed morbidity, and restenosis (gre ater than or equal to 50%). Results: The two groups were found to be s imilar for age, sex ratio, and associated diseases. The indications fo r surgery were transient ischemic attack (TIA) (57% ECEA, 64% SCEA), p revious stroke with minimal residual deficit (9% ECEA, 17% SCEA), and asymptomatic high-grade stenosis (34% ECEA, 19% SCEA). The average ope rative time for ECEA was significantly less (99.2 vs 135.2 minutes, P < 0.02). The mean blood loss was also less for ECEA (86 vs 181 cc). Tw o SCEA patients had immediate postoperative thrombosis resulting in 1 cerebrovascular accident (CVA) (1.8%), and 3 SCEA patients had cranial nerve injuries. In follow-up, 1 patient with SCEA had restenosis and 1 had a CVA unrelated to carotid disease. Morbidity associated with EC EA included 1 unsuccessful ECEA requiring interposition vein grafting and 1 intraoperative repair of-an intimal flap. There was no associate d residual morbidity. There was no significant difference in stroke ra te between the two groups. The operative cost (excluding surgeon fee) was 28% higher for SCEA patients. Conclusion: Eversion carotid endarte rectomy is a safe procedure and can be an important addition to a surg eon's armamentarium in efforts to cut costs while maintaining quality.