Eversion endarterectomy of the carotid artery: Technical considerations and recurrent stenoses

Purpose: The purpose of this study was to examine the characteristics of re sidual and recurrent lesions after eversion endarterectomy of the carotid a rtery (E-CE) and compare these results with those following endarterectomy and patch closure (CE-P). Methods: We reviewed 274 patients who underwent carotid endarterectomy in 1 998 with electroencephalographic monitoring, general anesthesia, completion duplex scan, and 1-year follow-up. CE-P was preferred for patients who req uired temporary shunting. In the E-CE group an additional proximal 2-cm art eriotomy was made in the common carotid artery (CCA) in 79 patients, a long er arteriotomy was made for extensive involvement of the CCA in 14 patients , and the internal carotid artery was advanced proximally as a patch for th e CCA. arteriotomy closure in 14 patients. Stenoses of > 50% that were pres ent at 1 month were considered residual, and those of > 50% that were prese nt at 1 year but not at 1 month were considered recurrent. Results: There were five (1.8%) postoperative strokes (four after CE-P and one after ECE, P = not significant). At 30 days there were 28 patients (10. 2%) with residual stenoses > 50% (11 patients [10.2%] in the E-CE group and 17 patients [10.1%] in the CE-P group; P = not significant). The incidence of recurrent lesions of more than 50% was similar (4.6% for E-CE vs 4.7% f or CE-P). Conclusion: The pattern of residual lesions and recurrent stenoses differs with each technique of endarterectomy. Proximal stenoses are more common af ter E-CE, and distal stenoses are more common after CE-P at both 1 month an d 1 year. The frequency of proximal lesions is reduced in E-CE when either the internal carotid artery is advanced proximally onto the CCA or a long C CA arteriotomy is made. Distal recurrences do not seem to be a problem afte r eversion endarterectomy.