Eversion endarterectomy of the carotid artery: technical considerations and recurrent stenoses.

Published

Journal Article

PURPOSE: The purpose of this study was to examine the characteristics of residual and recurrent lesions after eversion endarterectomy of the carotid artery (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 1998 with electroencephalographic monitoring, general anesthesia, completion duplex scan, and 1-year follow-up. CE-P was preferred for patients who required temporary shunting. In the E-CE group an additional proximal 2-cm arteriotomy was made in the common carotid artery (CCA) in 79 patients, a longer arteriotomy was made for extensive involvement of the CCA in 14 patients, and the internal carotid artery was advanced proximally as a patch for the CCA arteriotomy closure in 14 patients. Stenoses of > 50% that were present at 1 month were considered residual, and those of > 50% that were present 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 E-CE, 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% for CE-P). CONCLUSION: The pattern of residual lesions and recurrent stenoses differs with each technique of endarterectomy. Proximal stenoses are more common after E-CE, and distal stenoses are more common after CE-P at both 1 month and 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 CCA arteriotomy is made. Distal recurrences do not seem to be a problem after eversion endarterectomy.

Full Text

Duke Authors

Cited Authors

  • Green, RM; Greenberg, R; Illig, K; Shortell, C; Ouriel, K

Published Date

  • December 2000

Published In

Volume / Issue

  • 32 / 6

Start / End Page

  • 1052 - 1061

PubMed ID

  • 11107076

Pubmed Central ID

  • 11107076

International Standard Serial Number (ISSN)

  • 0741-5214

Digital Object Identifier (DOI)

  • 10.1067/mva.2000.111283

Language

  • eng

Conference Location

  • United States