Carotid Eversion Endarterectomy and Reimplantation: A Safe and Simple Technique to Prevent Acute Thrombosis—Occlusion and/or Early and Late Restenosis

Abstract

The purpose of this report is to consider the technical aspects of carotid eversion endarterectomy and reimplantation into the common carotid artery for surgical treatment of atherosclerotic occlusive disease, in light of previous early and late results. In the past 2 years, the authors have more frequently used carotid eversion endarterectomy and reimplantation to minimize the risk of perioperative stroke due to acute occlusion–thrombosis, and the incidence of early and late restenosis. Some 88 patients underwent 95 carotid eversion endarterectomies and reimplantation (seven bilateral): 59 internal carotid arteries were surgically corrected for ischaemic symptoms while 36 patients were symptomless but presented with a haemodynamically significant stenosis at the internal carotid artery bifurcation. The ischaemic preoperative symptoms consisted of one or more transient ischaemic attack's in 39 patients (66%), amaurosis fugax in 15 (25%) and mild stroke in five (8%). Associated elongation of the internal carotid artery beyond the end of the plaque was present in 81 cases (85%). After freeing the internal carotid artery sufficiently beyond the distal limit of the lesion, the vessel was transected obliquely to its origin, the extramedial cleavage plane opened and the endarterectomized arterial wall everted beyond the natural end of the plaque, which was gently removed. The artery was dilated distally and finally reimplanted end-to-side into the common carotid artery, 1–2 cm or more above the original site. This technique has provided excellent early and late results: no deaths, no acute thrombosis–occlusion, no minor or major stroke occurred perioperatively. No restenosis, no symptomless or symptomatic late occlusion was found during late follow-up (mean 28 (range 6–44) months). The performance of this vascular technique must be encouraged and recommended because of its speed, effectiveness and success. Carotid eversion endarterectomy and reimplantation should be performed routinely when the internal carotid artery is elongated.