CAROTID ENDARTERECTOMY BY EVERSION TECHNIQUE - ITS SAFETY AND DURABILITY

Summary Background Data The outcome of standard longitudinal carotid e ndarterectomy (CEA) can be measured by preservation of neurologic func tion with a low incidence of restenosis. Closure of the internal carot id arteriotomy with or without a patch may predispose to restenosis, A lternatively, transection of the internal carotid artery at the bulb w ith eversion endarterectomy allows expeditious removal of the plaque a nd direct visualization of the endpoint. Because the proximal internal carotid artery is anastomosed to the common carotid artery, this obvi ates the need for patch closure. The authors report their results with this technique in more than 2200 procedures, Methods From May 1993 to March 1998, 1855 patients underwent 2249 CEAs using the eversion tech nique. During the same period, 410 patients had 474 CEAs by standard t echnique. Three hundred fifteen procedures in the eversion group and 6 5 procedures in the standard group were combined CEA and coronary arte ry bypass grafts. Most solo CEAs (97%) were performed in awake patient s using regional anesthesia. Shunts were used on demand in 6% of CEAs. Results The operative mortality rate was 1.02% (16/1575) in the solo eversion group and 2.2% (9/410) in the standard group. There were 18 p ermanent neurologic deficits (0.8%) in the eversion group and 11 (2.3% ) in the standard group. Transient neurologic deficits occurred in 20 patients (0.9%) in the eversion group and 13 patients (2.7%) in the st andard group, Of the 1855 patients, 1786 (96%) presented for duplex ul trasound follow-up. There were seven (0.3%) stenoses greater than 60% in the eversion group Versus live (1.1%) in the standard group. Conclu sions Eversion CEA can be performed safely with a low rate of stroke a nd death and a minimal restenosis rate in short- and long-term follow- up.