Single center experience on eversion versus standard carotid endarterectomy: a prospective non-randomized study

Background and purpose: The prospective studies that have compared the outc omes of eversion and standard longitudinal carotid endarcterectomy (CEA) ha ve been few and small and available data to reach definitive conclusions ar e still scarce. This prospective, non-randomized study sought to compare ev ersion and standard CEA for early and late mortality and morbidity and the incidence of late restenosis. Methods: Between 1992 and 1997, we performed 2806 CEAs in 2469 patients (21 24 eversion CEAs in 1859 patients and 682 standard CEAs in 610 patients), A ll patients underwent preoperative neurological examination and cervical du plex scanning. Patients were followed up by neurological evaluation and dup lex scanning at 1 and 6 months after CEA, and yearly afterwards. Results: Demographics and neurologic inidications for CEA were similar in b oth groups, Mean clamping time was shorter in the eversion CEA group (13.5 +/- 6.1 vs 19.9 +/- 19.1 min, P < 0.001), Early (30-day) postoperative mort ality due to major stroke was lower after eversion CEA (10/2124 vs 9/682, P = 0.037), as well as total cardiovascular mortality (16/2124 vs 12/682, P = 0.038). Early carotid occlusion was more frequent in standard CEA group ( 12/2124 vs 11/682, P = 0.017), as well as total early morbidity (112/2124 v s 53/682, P < 0.001). During follow-up (mean 56 months, range 6-92), resten osis rate was lower in the eversion CEA group (0.5 vs 1.8%, P = 0.006). Conclusions: Our data indicate that eversion CEA as compared to standard CE A technique is associated with lower total cardiovascular perioperative mor tality and mortality due to major stroke, shorter clamping time, lower earl y occlusion rate, and lower late restenosis rate. (C) 2000 The Internationa l Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. Al l rights reserved.