Eversion endarterectomy of the internal carotid artery: Technique and results in 449 procedures

Background. Preservation of neurological function with a low incidence of restenosis is a measure of the long-term durability of carotid endarterectomy. Routine and selective patch angioplasty of the internal carotid artery have both been used to reduce the incidence of restenosis. The European literature has had many reports of lower restenosis rates in patients undergoing eversion carotid endarterectomy. We evaluated our experience with the eversion carotid endarterectomy procedure over a 2-year period to identify any advantage of this technique. Methods. Between August 1993 and August 1995, 376 patients underwent 449 carotid endarterectomies (CEAs) using the eversion technique (described below). During the same period 307 patients underwent 353 CEAs by standard endarterectomy. Demographics were similar in both groups. Fifty-two patients in the eversion group underwent combined open cardiac procedures and carotid endarterectomy. There were 47 such patients in the standard group. Duplex examination was performed after surgery at regular intervals to identify any recurrent stenosis. Results. Operative mortality was 4 of 376 (1.1%) and 6 of 307 (2%) in the eversion and standard groups, respectively. Shunts were used in 15 of 449 patients in the eversion group and 24 of 353 patients in the standard group. Cervical block anesthesia was used in 669 of 687 (97%) of patients undergoing CEA without coronary artery bypass grafting (CABG). There were four permanent neurologic deficits in the eversion group and seven in the standard group, for respective stroke rates of 0.9% and 2%, and there were three transient neurologic deficits in the eversion group and nine in the standard group. There was one (0.2%) restenosis in the eversion group; there were four (1.1%) in the standard group by follow-up duplex scan. Conclusions. These data demonstrate that eversion carotid endarterectomy can be performed with low stroke and mentality rates in the treatment of extracranial carotid occlusive disease. The incidence of restenosis was lower and approached significance in eversion endarterectomy when compared to standard carotid endarterectomy in the short-term follow-up in this series.