Selective carotid endarterectomy brings about the advantages of conventional and eversion endarterectomy

2013 ◽  
Vol 61 (S 01) ◽  
Author(s):  
B Emrecan ◽  
G Önem ◽  
AC Özdemir
Keyword(s):  
Carotid Endarterectomy ◽  
Eversion Endarterectomy

Surgical Treatment of Carotid Artery Disease

2020 ◽  
Author(s):  
Wesley S. Moore
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Carotid Artery Disease ◽  
Carotid Bifurcation ◽  
Eversion Endarterectomy ◽  
Artery Disease ◽  
Carotid Arterial

The rationale for operating on patients with carotid artery disease is to prevent stroke. It has been estimated that in 50 to 80% of patients who experience an ischemic stroke, the underlying cause is a lesion in the distribution of the carotid artery, usually in the vicinity of the carotid bifurcation. Appropriate identification and intervention could significantly reduce the incidence of ischemic stroke. Carotid endarterectomy for both symptomatic and asymptomatic carotid artery stenosis has been extensively evaluated in prospective, randomized trials. Surgical reconstruction of the carotid artery yields the greatest benefits when done by surgeons who can keep complication rates to an absolute minimum. The majority of complications associated with carotid arterial procedures are either technical or judgmental; accordingly, this review emphasizes the procedural aspects of planning and operation considered to be particularly important for deriving the best short- and long-term results from surgical intervention. Specifically, this review covers preoperative evaluation, operative planning, operative technique, postoperative care, follow-up, and alternatives to direct carotid reconstruction. Figures show carotid arterial procedures including recommended patient positioning, the commonly used vertical incision, the alternative transverse incision, mobilization of the sternocleidomastoid muscle to identify the jugular vein, palpation of the internal carotid artery, division of the structures between the internal and external carotid arteries to allow the carotid bifurcation to drop down, division of the posterior belly of the digastric muscle to yield additional exposure of the internal carotid artery, a graphic representation of the measurement of internal carotid artery back-pressure, a central infarct zone surrounded by an ischemic zone, shunt placement, open endarterectomy, eversion endarterectomy, repair of fibromuscular dysplasia, and repair of coiling or kinking of the internal carotid artery. This review contains 17 figures, and 25 references Key words: Carotid artery disease; Carotid endarterectomy; Carotid angioplasty with stenting; Eversion endarterectomy; Open endarterectomy; Carotid plaque; TCAR  

scholarly journals Carotid Endarterectomy: A Review

2004 ◽  
Vol 31 (1) ◽  
pp. 22-36 ◽  
Author(s):  
J. Max Findlay ◽  
B. Elaine Marchak ◽  
David M. Pelz ◽  
Thomas E. Feasby
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Case Series ◽  
Routine Practice ◽  
Complication Rates ◽  
Carotid Angioplasty ◽  
Catheter Angiography ◽  
Eversion Endarterectomy ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Background:Since the validation of carotid endarterectomy (CEA) as an effective means of stroke prevention, there has been renewed interest in its best indications and methods, as well as in how it compares to carotid angioplasty and stenting (CAS). This review examines these topics, as well as the investigation of carotid stenosis and the role of auditing and reporting CEAresults.Investigation:Brain imaging with CTor MRI should be obtained in patients considered for CEA, in order to document infarction and rule out mass lesions. Carotid investigation begins with ultrasound and, if results agree with subsequent, good-quality MRAor CTangiography, treatment can be planned and catheter angiography avoided. An equally acceptable approach is to proceed directly from ultrasound to catheter angiography, which is still the gold-standard in carotid artery assessment.Indications:Appropriate patients for CEA are those symptomatic with transient ischemic attacks or nondisabling stroke due to 70-99% carotid stenosis; the maximum allowable stroke and death rate being 6%. Uncertain candidates for CEA are those with 50 - 69% symptomatic stenosis, and those with asymptomatic stenosis ≥ 60% but, if selected carefully on the basis of additional risk factors (related to both the carotid plaque and certain patient characteristics), some will benefit from surgery. Asymptomatic patients will only benefit if surgery can be provided with exceptionally low major complication rates (3% or less). Inappropriate patients are those with less than 50% symptomatic or 60% asymptomatic stenosis, and those with unstable medical or neurological conditions.Techniques:Carotid endarterectomy can be performed with either regional or general anaesthesia and, for the latter, there are a number of monitoring techniques available to assess cerebral perfusion during carotid cross-clamping. While monitoring cannot be considered mandatory and no single monitoring technique has emerged as being clearly superior, EEG is most commonly used. “Eversion” endarterectomy is a variation in surgical technique, and there is some evidence that more widely practiced patch closure may reduce the acute risk of operative stroke and the longer-term risk of recurrent stenosis.Carotid angioplasty and stenting:Experience with this endovascular and less invasive procedure grows, and its technology continues to evolve. Some experienced therapists have reported excellent results in case series and a number of randomized trials are now underway comparing CAS to CEA. However, at this time it is premature to incorporate CAS into routine practice replacing CEA.Auditing:It has been shown that auditing of CEA indications and results with regular feed-back to the operating surgeons can significantly improve the performance of this operation. Carotid endarterectomy auditing is recommended on both local and regional levels.

scholarly journals Techniques in carotid artery surgery

2008 ◽  
Vol 24 (2) ◽  
pp. E18 ◽  
Author(s):  
Jonathan Andrew Curtis ◽  
Kaj Johansen
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Stroke Unit ◽  
Primary Repair ◽  
Complete Removal ◽  
Major Objective ◽  
Carotid Artery Surgery ◽  
Eversion Endarterectomy

✓The major objective in carotid endarterectomy is to achieve safe and complete removal of intimal plaque and provide lasting, nonstenotic closure. Controversy exists as to which technical variation best achieves this. In this paper, the authors review the operative nuances and outcomes with conventional and eversion endarterectomy, with a focus on the latter. The views expressed reflect specific neurosurgical and vascular perspectives in the context of a multi-disciplinary stroke unit, where carotid stenosis is managed with all available open and endovascular means. The neurosurgical approach was almost entirely conventional endarterectomy with primary repair, while the vascular surgeons used the eversion method with few exceptions.

Selective carotid endarterectomy and the advantages of conventional and eversion endarterectomy

2014 ◽  
Vol 18 (4) ◽  
pp. 179-183
Author(s):  
Bilgin Emrecan ◽  
Ahmet Coskun Ozdemir ◽  
Gokhan Onem
Keyword(s):  
Carotid Endarterectomy ◽  
Eversion Endarterectomy

Surgical Treatment of Carotid Artery Disease

2020 ◽  
Author(s):  
Wesley S. Moore
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Carotid Artery Disease ◽  
Carotid Bifurcation ◽  
Eversion Endarterectomy ◽  
Artery Disease ◽  
Carotid Arterial

The rationale for operating on patients with carotid artery disease is to prevent stroke. It has been estimated that in 50 to 80% of patients who experience an ischemic stroke, the underlying cause is a lesion in the distribution of the carotid artery, usually in the vicinity of the carotid bifurcation. Appropriate identification and intervention could significantly reduce the incidence of ischemic stroke. Carotid endarterectomy for both symptomatic and asymptomatic carotid artery stenosis has been extensively evaluated in prospective, randomized trials. Surgical reconstruction of the carotid artery yields the greatest benefits when done by surgeons who can keep complication rates to an absolute minimum. The majority of complications associated with carotid arterial procedures are either technical or judgmental; accordingly, this review emphasizes the procedural aspects of planning and operation considered to be particularly important for deriving the best short- and long-term results from surgical intervention. Specifically, this review covers preoperative evaluation, operative planning, operative technique, postoperative care, follow-up, and alternatives to direct carotid reconstruction. Figures show carotid arterial procedures including recommended patient positioning, the commonly used vertical incision, the alternative transverse incision, mobilization of the sternocleidomastoid muscle to identify the jugular vein, palpation of the internal carotid artery, division of the structures between the internal and external carotid arteries to allow the carotid bifurcation to drop down, division of the posterior belly of the digastric muscle to yield additional exposure of the internal carotid artery, a graphic representation of the measurement of internal carotid artery back-pressure, a central infarct zone surrounded by an ischemic zone, shunt placement, open endarterectomy, eversion endarterectomy, repair of fibromuscular dysplasia, and repair of coiling or kinking of the internal carotid artery. This review contains 17 figures, and 25 references Key words: Carotid artery disease; Carotid endarterectomy; Carotid angioplasty with stenting; Eversion endarterectomy; Open endarterectomy; Carotid plaque; TCAR  

scholarly journals Long-term results of eversion surgeries for internal carotid artery stenosis due to atherosclerosis

2015 ◽  
Vol 96 (3) ◽  
pp. 337-340
Author(s):  
I R Zakirov ◽  
I R Yagafarov ◽  
M G Khatypov ◽  
N G Sibagatullin ◽  
M Kh Zakirzyanov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Long Term Results ◽  
Aim Analysis ◽  
Eversion Endarterectomy

Aim. Analysis of long-term results of eversion carotid endarterectomy in patients with atherosclerotic carotid stenosis.Methods. 272 eversion carotid endarterectomy surgeries was performed from June 2008 to December 2014 in the department of cardiac surgery. Long-term results were studied in 198 (73%) patients, with follow-up term ranging from 6 to 48 months. The method of operation serves as a criterion separating Patients were allocated into two groups by the surgery method: in the first group, eversion endarterectomy was performed by Kieny, in the second - by DeBakey.Results. Reconstructed ipsilateral internal carotid artery was passable during the follow-up period in 100% of cases, as confirmed by ultrasonography. In the late period, the mortality in the first group was 2.3% (myocardial infarction and cancer), compared to 1.5% in the second group (myocardial infarction). Acute ischemic stroke occurred in 0.8% of the first group patients and in 1.5% of the second group patients. Restenosis of 50 to 69% were discovered in 3.7% of cases in first group and in 3% in the second group. Restenosis ≥70% were found in 1.5% in both groups of patients.Conclusion. The obtained data confirm that both methods of eversion carotid endarterectomy are safe and reliable in treatment of carotid arteries atherosclerosis and, thus, preventing stroke.

scholarly journals Comparative analysis of conventional and eversion carotid endarterectomy: Prospective randomized study

2008 ◽  
Vol 136 (11-12) ◽  
pp. 590-597 ◽  
Author(s):  
Dragan Markovic ◽  
Lazar Davidovic ◽  
Zivan Maksimovic ◽  
Ilija Kuzmanovic ◽  
Nikola Ilic
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Randomized Study ◽  
Neurological Complications ◽  
Long Term Results ◽  
Eversion Endarterectomy ◽  
Significant Difference

INTRODUCTION Studies completed in the last decade of the 20th century showed benefits of carotid endarterectomy in the prevention of stroke in patients with a high-grade stenosis of the internal carotid artery. OBJECTIVE The aim of this prospective, randomized study was the comparison of early and long-term results between the conventional and eversion carotid endarterectomy, and literature review. METHOD By the method of random choice, 103 patients were operated on using the eversion carotid endarterectomy and 98 patients using the conventional technique. Operative treatment was carried out under general anaesthesia. Following the clammping of the carotid artery, retrograde blood pressure was determined by a direct puncture of the internal carotid artery above the stenotic lesions. In patients with retrograde pressure below 20 mm Hg intraluminal shunting was routinely performed. Early results were estimated (during the first seven postoperative days) based on mortality, central neurological complications (stroke, TIA) and cranial or cervical nerve lesions. Long-term results were estimated (after at least two years) based on long-term survival rate, central neurological complications (stroke, TIA) and the incidence of haemodynamically significant restenosis of the carotid artery treated by endarterectomy. RESULTS The average time of clamming of the internal carotid artery in the eversion carotid anderectomy group was 5.36 minutes shorter than in the group treated by the conventional technique. Student's t-test showed a statistically highly significant difference in the time needed for clamming of the internal carotid artery between the two groups. The average duration of eversion endarterectomy (82 minutes) was most often 19 minutes shorter than the duration of the conventional endarterectomy (101 minutes). Student's t-test showed a statistically highly significant difference in the average length of surgeries. The distal intimal fixation was more often needed during the conventional carotid endarterectomy (34.7%) compared to eversion endarterectomy (3.9%). ?2-test showed a statistically highly significant difference. CONCLUSION Eversion carotid endarectomy represents a statistically significantly shorter procedure. Distal intimal fixation demanded by this procedure is very rare, clammping of the internal carotid artery is significantly shorter, and it also has a lower rate of the early neurological complications. Based on the results of this study, as well as the opinions of other authors, it can be concluded that the eversion carotid endarterectomy has an advantage over the conventional procedure. We recommend conventional procedure only in cases when retrograde pressure indicates the use of the intraluminal shunting.

scholarly journals Patch Angioplasty or Primary Closure Following Carotid Endarterectomy for Symptomatic Carotid Artery Stenosis

2018 ◽  
Vol 04 (02) ◽  
pp. e96-e101 ◽  
Author(s):  
Eline Huizing ◽  
Cornelis Vos ◽  
Robin Hulsebos ◽  
Peter van den Akker ◽  
Gert Borst ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Primary Closure ◽  
Group Versus ◽  
Patient Characteristics ◽  
Symptomatic Carotid ◽  
Patch Angioplasty ◽  
Eversion Endarterectomy ◽  
Patch Closure ◽  
Symptomatic Stenosis

Objectives Guidelines recommend routine patching to prevent restenosis following carotid endarterectomy, mainly based on studies performed many years ago with different perioperative care and medical treatment compared with current standards. Aim of the present study was to compare primary closure (PRC) versus patch closure (PAC) in a contemporary cohort of patients. Methods Consecutive patients treated by carotid endarterectomy for symptomatic stenosis between January 2006 and April 2016 were retrospectively analyzed. Primary outcome was restenosis at 6 weeks and 1 year and occurrence of ipsilateral stroke. Secondary outcomes were mortality, complications, and reintervention rates. Results Five hundred carotid artery endarterectomies were performed. Fifty-nine patients were excluded because eversion endarterectomy was performed or because they were asymptomatic. PRC was performed in 349 and PAC in 92 patients. Restenosis at 6 weeks was 6.0% in the PAC group versus 3.0% in the PRC group (p = 0.200). Restenosis at 1 year was 31.6 versus 14.1%, respectively (p = 0.104). No difference was found for stroke (3.4 vs 1.1%, p = 0.319), death (1.1 vs 0.0%, p = 0.584), or other complications (1.1 vs 0.0%, p = 0.584), respectively. Conclusions It remains unclear whether routine patching should be recommended for all patients. A strategy of selective patching compared with routine patching, based on internal carotid artery diameter and other patient characteristics, deserves further investigation.

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