Surgical carotid endarterectomy - the gold standard

In a retrospective study we examined the possible of obtaining better resul ts with a new operation technique of the carotid artery, the so-called "no- touch isolation" in corn parison with conventional operation technique. Patients and methods: 49 patients: who had been operated in 1997 and 1998 b y this new operation technique, were compared with a group of 39 patients, who had been previously operated with the conventional technique. The new , ,no-touch isolation" technique is aimed at avoiding possible intraoperative and postoperative embolies. First, the carotis internal artery was exposed and clamped distal to the stenotic plaque very atraumatically The operatio n was further carried out without the use of an intraluminal shunt. At the end of the procedure the operation results were checked by means of an intr aoperative angiography. In case of a possible embolization source, Like pie ces of intima, an intraoperative revision was carried out until all emboliz ation material was removed. Results: The two compared groups were not different regarding age, sex, sym ptomatology, degree of stenosis, and risk factors. No significant differenc es in context with the applied operation method for TEA (with or without pa tch, Eversions-TEA, etc.) could be detected. The group operated with the "n o-touch isolation" technique had significantly longer operation times and a lso significantly longer clamping-times than the group operated with the co nventional technique. However, the postoperative results were better. Signi ficantly fewer neurological deficits appeared and, in addition significantl y fewer patients had to be revised because of secondary hemorrhages. Conclusion: The "no-touch isolation" technique is, at the moment, the best surgical procedure for the carotid artery. It is the method of choice for p atients with symptomatic stenosis of the internal carotid artery with more than 70 % stenotic degree.