Comparison of conventional surgical method and eversion technique in carotid endarterectomy operations

Abstract

Background/Aim: Carotid endarterectomy is a highly effective and safe operation for preventing the risk of stroke in patients with symptomatic internal carotid artery stenosis. Several surgical techniques were described and available: Conventional carotid endarterectomy (CCEA) and eversion carotid endarterectomy (ECEA) are the two most common. Superiority of these two techniques to one another has not yet been clearly demonstrated. We aim to demonstrate the surgical and clinical experience of our institution regarding these two approaches. Methods: In this retrospective cohort study, forty-three consecutive patients operated for symptomatic carotid stenosis were divided into two groups according to the preferred surgical method (CCEA and ECEA), and compared in terms of postoperative hospital stay, use of shunts and antibiotics, early (30-day) complications, long-term restenosis, and mortality rates. Results: Demographic data and preoperative stenosis rates were similar between the two groups (P>0.05). In the CCEA group, subjects had a significantly longer clamping time (19.3 (4.1) vs 15.4 (3.4) min., P=0.002) and significant differences were found between operative time (35.1 (3.2) vs 28.7 (4.3) min) and need for shunting (25.7% vs 2.1%, P<0.001). CCEA patients had a higher percentage of antibiotic use (49.8% vs. 31.1%, P=0.04). Hematoma rates, complications during follow up, including stroke, heart attack, and mortality rate were similar between the groups, along with re-stenosis (P=0.754) and survival rates (P=0.241), according to Kaplan-Meier analysis. Conclusions: Our results showed that ECEA was a convenient surgical technique and more advantageous compared to CCEA with respect to early and long term follow up results. ECEA can be performed within a significantly shorter operative time and may decrease the necessity for shunting, although it may require specific experience.