CAROTID ENDARTERECTOMY BY THE EVERSION ME THOD - ONE-YEAR ARTERIOGRAPHICAL RESULTS

A prospective study was done in 100 patients operated on for a stenosi s of the carotid artery by the eversion endarterectomy method of Van M aele (section-eversion-anastomosis) between January 1994 and August 19 95. Ten patients were operated on bilaterally (thus, 110 procedures). The distribution of the patients was as follows 81 males and 19 female s, mean age 71 years. Clinically, 50 patients were asymptomatic, 44 st age I, 2 stage II and 3 stage III. Arteriography of these patients sho wed 42 stenoses greater than or equal to 90 %, 56 stenoses between 70 and 90 % and 12 ulcerated plaques (according to the ESCT measurement s tandards). Concerning the supra-aortic vessels, 24 lesions of the vert ebral-subclavian branches and 21 lesions of the intra-cerebral vessels were observed. Five endarterectomies out of the 110 (5.4 %) could not be performed by this eversion method because of the immediate poor te chnical result before angiography. At the end of the procedure digital angiography was performed for all the patients who underwent an evers ion endarterectomy (105 cases). Six images of the internal carotid art ery presenting stenoses less than 30 % were observed at the level of t he implantation site. Two narrow stenoses of the distal part of the en darterectomy made the interposition of a PTFE graft necessary in 20 % of the cases, a secondary procedure was necessary after the peri-opera tive angiography 2 implantations of PTFE in the internal carotid arter y, 8 additional endarterectomies of the external carotid artery, 11 in filtrations with Papaverine. The immediate post-operative results were 1 death after hemiplegia, 1 hemiplegia with sequelae (mortality/morbi dity approximately 2 %, i.e 2/103 eversions), 3 regressive hemipareses . Angiographic follow-ups after 1 year were performed on 100 out of 11 0 operated carotid arteries. With regard to the internal carotid arter y, 4 patients showed a stenosis less than 30 8, 1 patient a 50 % steno sis, I patient a pre-occlusive stenosis making an operation with the i nterposition of a PTFE graft necessary (restenosis rate after one year 2 %). All the patients followed after one year remained asymptomatic. Eversion endarterectomy is possible for the majority of the atheromat ous stenoses of the carotid artery (5.4 % were not possible for techni cal reasons). We fmd this method not appropriate when a shunt must be placed. Immediate results are comparable to those of classical surgica l endarterectomy with or without patching. The restenosis rate at 1 ye ar in our series is 2 %. This technique provides an excellent anatomic result by peri-operative angiography and can especially be adapted to stenoses with excess of length of the carotid artery.