Technique of Eversion Carotid Endarterectomy and Contemporary Results

Abstract

Eversion endarterectomy (ECEA) of the carotid artery by Debakey et al. in 1959 made eversion of the internal carotid artery difficult and provided limited visualization of the end point of the endarterectomy. In this study we describe the technique of a modified ECEA and report our experience. Between May 1993 and August 1996, 1674 CEAs were performed in 1,391 patients for symptomatic disease or for asymptomatic stenosis (>70%). Preoperative evaluation was performed using duplex ultrasound, magnetic resonance angiography, and/or contrast angiography. Procedures were performed preferentially (>97%) under regional cervical block anesthesia in the awake patient. A shunt was used only for intraoperative neurologic deterioration. CEAs performed in patients combined with coronary artery bypass graft were performed under general anesthesia, a shunt was not used routinely in these patients. Data was prospectively collected in a vascular registry. Shunts were placed in 3.4% of ECEA. The operative mortality was 1.2% in the ECEA group and the stroke rate was 0.4% in the ECEA group. Similarly, occlusion rates of 0.4%. Mean follow-up was 7 months (range: 1-48). Postoperatively duplex scans were used to detect stenoses >50%. There was one restenosis (0.09%) at 15 months in the eversion group. There was one asymptomatic occlusion at five months in the ECEA group and two in the SCEA group at six and eight months. Four year cumulative patency rate was 98%. There has been no late stroke in either group on follow-up. The current method of eversion endarterectomy as outlined in our study is safe and reliable for the preservation of neurologic function.