Modified Method of Eversion Carotid Endarterectomy in Patients with Extensive Atherosclerotic Disease Of Carotid Bifurcation: Short-term Results

Abstract

Introduction: Performing eversion endarterectomy some difficulties arise. Firstly, it requires a great deal of coherence between the work of the surgeon and the first assistant, as well as a great experience of the latter. Secondly, in some cases, there are difficulties in visualizing the distal margin of the intima: in the absence of a rigid skeleton, the soft unchanged artery walls after removal of the plaque subside, making it difficult to visualize possible fragments of the intima. Thirdly, the cost of the error is high: with a random de-version, repeated eversion turns out to be impossible. It should be noted that the use of an eversion technique becomes difficult to implement, and sometimes impossible, with extended stenosis, since a very high allocation of the ICA is required, which increases the invasiveness of the operation and the difficulty of access. With prolonged stenosis, the carotid endarterectomy remains the option of choice. The modification used eversion carotid endarterectomy combines the advantages of both methods, and also eliminates the limitations of the carotid endarterectomy and eversion carotid endarterectomy. Methods: The study included 64 patients: 33 underwent eversion carotid endarterectomy (I group), and 31 - modified eversion carotid endarterectomy (II group). In 100% of cases, the intervention was performed under endotracheal anesthesia. Brain perfusion and the need for an intraluminal shunt were assessed using cerebral oximetra and retrograde pressure in the internal carotid artery. Exclusion criteria from the study: patients with a mouth injury of the ICA (plaque < 2 cm), patients with a contralateral occlusion of the ICA, patients with stroke in ischemic type in the acute period. Results: In our study, there were no cases of using a glove shunt. There were no hospital lethality, strokes, cases of transient ischemic attack and injuries of the cranial nerves in both groups. In group I, the clamping time of the internal carotid artery was 19.21 ± 1.47 minutes, versus 14.94 ± 1.39 minutes, p < 0.05 in group II, respectively. The patient's stay in the ICU in both groups did not exceed 1 day. In all patients, the wound healed by first intention. The average hospital stay did not exceed 6 days in both groups. Conclusion: The use of a modified eversion carotid endarterectomy technique can reduce the clamping time of the internal carotid artery and, as a consequence, reduce the time of cerebral ischemia in patients with common lesions of the common carotid artery bifurcation. Disclosure: Nothing to disclose