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...