Background: carotid sinus massage (CSM) is a valuable clinical test for carotid sinus syndrome (CSS) and relies on accurately locating the carotid sinus (CS). Objective: in this study, we sought to examine the accuracy of using anatomical landmarks for locating the CS. Methods: consecutive patients (n = 20) were recruited prospectively. Two clinicians, trained in CSM, were asked to locate the CS using anatomical landmarks. A point on the skin overlying the CS was then marked by a vascular technician using ultrasound. Accuracy of techniques was compared using intra-class correlation coefficients and Bland-Altman statistics. Results: anatomical landmarks underestimated the CS location by 1.5 ± 1.3 cm. Error extremes ranged from 4 cm below to 2 cm above CS using anatomical landmarks. A moderate correlation between ultrasound and anatomical landmarks was found, r = 0.371 (P = 0.031). Conclusion: this is the first study to characterise the accuracy of standard anatomical landmarks used in CSM. Results suggest that the point of maximal pulsation has the lowest associated error. Future work should examine CSM yield across this and a range of other methodological factors.

Hospital, by the senior author were included. Data was collected from statistics department, theatre database, discharge registry, ICU and HDU register and patient clinical notes. Study end-points included operative time, shunt use, perioperative stroke, 30 day mortality, restenosis and re intervention. Results: 114 cCEA procedures were undertaken from July 2008 to December 2011, while 63 eCEA performed during Jan 2012 to July 2014. Results are shown in Table 1. Intraarterial shunts were used in 19 % of cCEA and 1.6% of eCEA cases. Patients were followed postoperatively by Duplex imaging. Death and stroke rate in both groups was 0 %. Operative time for eCEA was significantly less that the cCEA. There were 5 restenosis in cCEA and only one in eCEA (range 20 to 70%). Conclusion: eCEA is safe and effective technique for carotid endarterectomy. It significantly reduces the operative time with low re-stenosis rate.