EVERSION ENDARTERECTOMY OF THE INTERNAL CAROTID-ARTERY - TECHNIQUE AND RESULTS IN 449 PROCEDURES

Background. Preservation of neurological function with a low incidence of restenosis is a measure of the long-term durability of carotid end arterectomy. Routine and selective patch angioplasty of the internal c arotid artery have both been used to reduce the incidence of restenosi s. The European literature has had many reports of lower restenosis ra tes in patients undergoing eversion carotid endarterectomy. We evaluat ed our experience with the eversion carotid endarterectomy procedure o ver a 2-year period to identify any advantage of this technique. Metho ds. Between August 1993 and August 1995, 376 patients underwent 449 ca rotid endarterectomies (CEAs) using the eversion technique (described below). During the same period 307 patients underwent 353 CEAs by stan dard endarterectomy. Demographics were similar in both groups. Fifty-t wo patients in the eversion group underwent combined open cardiac proc edures and carotid endarterectomy. There were 47 such patients in the standard group. Duplex examination was performed after surgery at regu lar intervals to identify any recurrent stenosis. Results. Operative m ortality was 4 of 376 (1.1%) and 6 of 307 (2%) in the eversion and sta ndard groups, respectively. Shunts were used in 15 of 449 patients in the eversion group and 24 of 353 patients in the standard group. Cervi cal block anesthesia was used in 669 of 687 (97%) of patients undergoi ng CEA without coronary artery bypass grafting (CABG). There were four permanent neurologic deficits in the eversion group and seven in the standard group, for respective stroke rates of 0.9% and 2%, and there were three transient neurologic deficits in the eversion group and nin e in the standard group. There was one (0.2%) restenosis in the eversi on group; there were four (1.1%) in the standard group by follow-up du plex scan. Conclusions. These data demonstrate that eversion carotid e ndarterectomy can be performed with low stroke and mentality rates in the treatment of extracranial carotid occlusive disease. The incidence of restenosis was lower and approached significance in eversion endar terectomy when compared to standard carotid endarterectomy in the shor t-term follow-up in this series.