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 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 Surgical Treatment of Proximal Segmental Occlusion of the Internal Carotid Artery

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Srdjan Babić ◽  
Slobodan Tanasković ◽  
Mihailo Nešković ◽  
Predrag Gajin ◽  
Dragoslav Nenezić ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Intracerebral Hemorrhage ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Long Term Results ◽  
Common Symptom ◽  
Coronary Syndrome

Purpose. To present the feasibility, safety, and efficacy of carotid endarterectomy in patients with type II internal carotid artery occlusions, including the long-term outcomes. Methods. From March 2008 to August 2015, 74 consecutive patients (48 men with a mean age of 65.1 ± 8.06 years) underwent carotid endarterectomy because of internal carotid artery (ICA) segmental occlusions. These were verified with preoperative carotid duplex scans (CDS) and CT angiography (CTA). Also, brain CT scanning was performed in all these patients. The indication for treatment was made jointly by a vascular surgeon, neurologist, and an interventional radiologist in a multidisciplinary team (MDT) context. After successful treatment, all the patients were followed-up at 1, 3, 6, and 12 months, then every 6 months thereafter. Results. The most common symptom at presentation was transient ischaemic attack (TIA) in 49 patients (66.2%), followed by stroke in the past six months in the 17 remaining patients (23%). Revascularisation of the ICA with endarterectomy techniques was performed successfully in all the patients with an average clamp time of 11.9 min. All the procedures were performed under general anaesthesia in combination with a superficial cervical block. The early complication rate was 8.1% and included two cardiac events (2.7%) (one rhythm disorder and one acute coronary syndrome), three TIAs (4.1%), and one intracerebral hemorrhage (1.3%). Only one patient with the intracerebral hemorrhage died 5 days after surgery giving a postoperative mortality of 1.3% for this series. During the follow-up period (mean 50.4 ± 31.3 months), the primary patency rates at 1, 3, 5, and 7 years were 98.4%, 94.9%, 92.9%, and 82.9%, respectively. Likewise, the survival rates were 98.7%, 96.8%, 89%, and 77.6%, respectively. Ultrasound Doppler controls during follow-up detected 8 ICA restenoses; however, only 3 of these patients required further endovascular treatment. Conclusions. Carotid endarterectomy of internal carotid artery (ICA) segmental occlusion is a safe and effective procedure associated with acceptable risk and good long-term results. Therefore, the current guidelines which do not recommend carotid endarterectomy in this patient group should be reassessed, with the requirement for ongoing large-scale randomized controlled trials to compare CEA with best medical therapy in this patient cohort.

Eversion carotid endarterectomy with transposition of the internal carotid artery according to A.N. Kazantsev. Hospital and long-term results.

2021 ◽  
Vol 29 (1) ◽  
pp. 73-88
Author(s):  
Anton N. Kazantsev ◽  
Konstantin P. Chernykh ◽  
Nona E. Zarkua ◽  
Artem D. Abdullaev ◽  
Anastasiya V. Povtoreiko ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Internal Carotid ◽  
Hypoglossal Nerve ◽  
Carotid Bifurcation ◽  
Long Term Results

Aim. This study provides an analysis of the results of eversion carotid endarterectomy (CEE) with transposition of the internal carotid artery (ICA) over the hypoglossal nerve, according to A.N. Kazantsev. Materials and Methods. The given prospective open study covering the period from January 2017 to May 2020 involved 311 patients who underwent eversion CEE with transposition of ICA over the hypoglossal nerve, according to A.N. Kazantsev. Transposition was performed in the following way: after standard isolation of the carotid arteries, their compression, arteriosection, and removal of atherosclerotic plaque, ICA was extracted in the area above the hypoglossal nerve and was implanted to the same position. The condition of the patient was controlled on repeated visits to the clinic every six months. Hemodynamics in the reconstruction zone were studied using multispiral computed tomography with angiography of carotid bifurcation with 0.6 mm steps and processing the obtained results in Sim Vascular and Open Foam programs in DICON format. The follow-up period was 18.37.1 months. In case of development of restenosis, reCEE was performed with patch plasty of the reconstruction zone. For histologic examination, the restenosis area was stained by the van Gieson method. Results. In the hospital follow-up period, one case of myocardial infarction was noted that developed due to the stents thrombosis in the anterior descending artery deployed two years before. When studying the hemodynamic properties of carotid bifurcation in the postoperative period using computer modeling, in all cases, no changes or obstacles to blood flow were formed in the ICA in the area above the hypoglossal nerve. In the long-term follow-up period, two cases of lethal outcome were recorded connected with the onset of an oncological disease. In one case, due to recurrence of the pulmonary artery thromboembolism. In two cases, the cause of myocardial infarction was thrombosis/occlusion of venous anastomoses (in one patient to the circumflex artery, in the other to the right coronary artery). In four cases, repeated acute cerebrovascular accidents developed due to restenosis after CEE. In cases of significant restenosis (n=8), reCEE was performed with plasty of the reconstruction zone with a patch. The average restenosis period was 8.23.6 months. No cardiovascular complications and cases of hypoglossal nerve traumatization were identified. Intraoperatively, it was confirmed that restenosis was formed in the bifurcation zone, in front of the perimeter of the primary arteriosection. According to the results of histological examination, the main cause of all restenoses was hyperplasia of the neointima. Conclusion. The eversion CEE with the transposition of the ICA, according to A.N.Kazantsev, creates conditions for additional maneuvers in case of restenosis and implementation of reCEE. The ICAs placement over the hypoglossal nerve during primary CEE allows more confident isolation of carotid artery bifurcation from scar tissues with a zero risk of damage to the hypoglossal nerve. Such a course of the operation makes it possible to apply a clamp on the ICA and perform arteriotomy in any location without the threat of injury to the nerve structures.

The Elongation of the Internal Carotid Artery: Early and Long-Term Results of Patients Having Surgery Compared with Unoperated Controls

1997 ◽  
Vol 11 (2) ◽  
pp. 120-128 ◽  
Author(s):  
Enzo Ballotta ◽  
Elvira Abbruzzese ◽  
Gaetano Thiene ◽  
Tomaso Bottio ◽  
Giuseppe Dagiau ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Long Term Results

scholarly journals Long-term Restenosis Rate of Eversion Endarterectomy on the Internal Carotid Artery

2004 ◽  
Vol 27 (5) ◽  
pp. 537-539 ◽  
Author(s):  
A. Szabo ◽  
E. Brazda ◽  
E. Dosa ◽  
A. Apor ◽  
Z. Szabolcs ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Restenosis Rate ◽  
Eversion Endarterectomy

scholarly journals Clipping on Crossed Wrapping Method for Ruptured Blood Blister-Like Aneurysm of the Internal Carotid Artery: Technical Note and Long-Term Results

2019 ◽  
Vol 2 ◽  
pp. 100005 ◽  
Author(s):  
Toru Nishi ◽  
Masatomo Kaji ◽  
Kazunari Koga ◽  
Shigeo Yamashiro ◽  
Takamasa Mizuno ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Technical Note ◽  
Long Term Results

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 Results of using the modified technique of eversion carotid endarterectomy in patients with extended atherosclerotic disease of bifurcation of common carotid artery

2021 ◽  
Vol 9 (3) ◽  
pp. 415-424
Author(s):  
V.A. Panfilov ◽  
◽  
A.O. Virganskiy ◽  
K.V. Romanenko ◽  
◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Atherosclerotic Plaque ◽  
Postoperative Period ◽  
Internal Carotid ◽  
Early Postoperative Period ◽  
Modified Technique ◽  
Results Of Treatment

BACKGROUND: Eversion carotid endarterectomy is one of the most frequently used methods of carotid endarterectomy. This is primarily due to the relative ease of surgical techniques, reduction in the risk of hemodynamic disorders in the reconstruction zone and the absence of the need to use synthetic material. The main disadvantage of eversion carotid endarterectomy is poor visualization of the distal edge of the atherosclerotic plaque and the lack of control of the unfixed edge of intima in common atherosclerotic lesion of the internal carotid artery. The use of a modified technique of eversion carotid endarterectomy avoids these disadvantages and preserves its advantages. AIM: to analyze the results of the use of modified eversion carotid endarterectomy in patients with extended disease to the internal carotid artery. MATERIALS AND METHODS: The study is based on the analysis of the results of treatment of patients with chronic cerebrovascular insufficiency due to extended atherosclerotic disease of the internal carotid artery, in whom eversion carotid endarterectomy was performed using a modified technique in the conditions of the Department of Vascular Surgery in Vinogradov City Hospital. The presence of an atherosclerotic plaque extending over a distance of more than 2.5 cm from the bifurcation was considered a common damage to the internal carotid artery. The assessment of intraoperative parameters, early postoperative period, as well as treatment results after 3, 6 and 12 months from the moment of surgery was carried out. RESULTS: The results of treatment of 60 patients in the early postoperative and long-term periods were analyzed. The average operation time was 71.37 ± 8.87 minutes. The average time for clamping the ICA was 18.35 ± 3.9 minutes. Transient ischemic attack in the early postoperative period occurred in 1 (1.7%) patient. Restenosis of the internal carotid artery (≥40%) on the side of the performed reconstruction developed in 3 (5.2%) patients. CONCLUSION: The risk of development of neurological disorders in the early postoperative period, as well as of restenosis of the area of surgical intervention in the long-term period when using the modified technique of eversion carotid endarterectomy, correspond to the data of modern world literature.

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