Durability of eversion carotid endarterectomy: Comparison with primary closure and carotid patch angioplasty

Katras, Tony; Baltazar, Ulises; Rush, Daniel S.; Sutterfield, W.Chris; Harvill, Leo M.; Stanton, Paul E.

doi:10.1067/mva.2001.117885

Cited by 65 publications

(50 citation statements)

References 28 publications

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“…However, longer operative time, and risk of rupture or aneurysm have been reported as disadvantages of patch plasty in some studies. [27,28] Myers et al compared patch plasty and primary closure in terms of restenosis. No significant difference was found, but study did not include females or patients whose internal carotid artery diameter ≤5 mm.…”

Section: Resultsmentioning

confidence: 99%

Awake Carotid Endarterectomy in Patients Undergoing Cardiac Surgery: Our 6 Years of Experience

Öz¹

2017

South Clin Ist Euras

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Objective: Optimal surgical approach for patients with hemodynamically significant carotid and cardiac disease remains controversial. Methods:Total of 370 randomized patients who underwent 412 carotid endarterectomies (42 cases were bilateral) and cardiac surgery between 2009 and 2014 were enrolled in the study. All patient data, including demographic details, risk factors, immediate perioperative events, 30-day and long-term outcome, were prospectively recorded and then analyzed statistically as mean and SD.Results: Of the patients, 29.4% (n=108) were female and 70.6% (n=262) were male. Mean age was 64 years (range: 42-86 years). In all, 37.03% (n=137) of the patients were defined as symptomatic. Asymptomatic severe carotid artery stenosis (≥70%) was diagnosed in 62.98% (n=233) of the patients. Mean observation time in intensive care unit following surgery was 2.84 (±1.20) hours and total hospital stay was 3.72 (±1.64) days. Restenosis was diagnosed in 7 (1.69%) of the patients during follow-up. Rate of cardiac events and stroke in postoperative early term were 2.94% and 0.72%, respectively. Conclusion:Awake carotid endarterectomy is safe and reliable procedure. Patient consciousness can be optimally evaluated during operation with regional anesthesia, thereby allowing for precise determination of need for shunt and avoiding unnecessary use.

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Section: Resultsmentioning

confidence: 99%

Awake Carotid Endarterectomy in Patients Undergoing Cardiac Surgery: Our 6 Years of Experience

Öz¹

2017

South Clin Ist Euras

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“…Numerous studies have compared C-CEA with patching with E-CEA. [15][16][17][18][19][20][21][22][23][24]29 Perhaps the most important of these is EVEREST (Eversion carotid Endarterectomy versus Standard Trial study), a randomized prospective multicenter study first published in 1998. 18 With the exception of the EVEREST and the findings of a few other reports, 30,31 the majority of studies found E-CEA to be as effective or superior to C-CEA with regard to perioperative stroke and death.…”

Section: Discussionmentioning

confidence: 99%

“…18 With the exception of the EVEREST and the findings of a few other reports, 30,31 the majority of studies found E-CEA to be as effective or superior to C-CEA with regard to perioperative stroke and death. 13,16,19,22,24,29,[32][33][34] In the EVEREST trial, 1353 patients were randomly assigned to E-CEA or C-CEA with shunting and patch closure of the arteriotomy left to the discretion of the operating surgeon. The conventional group consisted of 419 patients with primary arteriotomy closure and 256 patients with patch angioplasty.…”

Section: Discussionmentioning

confidence: 99%

Multicenter Experience on Eversion Versus Conventional Carotid Endarterectomy in Symptomatic Carotid Artery Stenosis

Demirel

Attigah

Bruijnen

et al. 2012

Stroke

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Background and Purpose— Carotid endarterectomy (CEA) is beneficial in patients with symptomatic carotid artery stenosis. However, randomized trials have not provided evidence concerning the optimal CEA technique, conventional or eversion. Methods— The outcome of 563 patients within the surgical randomization arm of the Stent-Protected Angioplasty versus Carotid Endarterectomy in Symptomatic Patients (SPACE-1) trial was analyzed by surgical technique subgroups: eversion endarterectomy versus conventional endarterectomy with patch angioplasty. The primary end point was ipsilateral stroke or death within 30 days after surgery. Secondary outcome events included perioperative adverse events and the 2-year risk of restenosis, stroke, and death. Results— Both groups were similar in terms of demographic and other baseline clinical variables. Shunt frequency was higher in the conventional CEA group (65% versus 17%; P <0.0001). The risk of ipsilateral stroke or death within 30 days after surgery was significantly greater with eversion CEA (9% versus 3%; P =0.005). There were no statistically significant differences in the rate of perioperative secondary outcome events with the exception of a significantly higher risk of intraoperative ipsilateral stroke rate in the eversion CEA group (4% versus 0.3%; P =0.0035). The 2-year risk of ipsilateral stroke occurring after 30 days was significantly higher in the conventional CEA group (2.9% versus 0%; P =0.017). Conclusions— In patients with symptomatic carotid artery stenosis, conventional CEA appears to be associated with better periprocedural neurological outcome than eversion CEA. Eversion CEA, however, may be more effective for long-term prevention of ipsilateral stroke. These findings should be interpreted with caution noting the limitations of the post hoc, nonrandomized nature of the analysis.

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“…68 Many other authors report the same findings, and the testimonies are reasonably consistent in stating that the commonly observed shorter ischemic times with eversion CE are due to the technically easier and structurally shorter anastomosis. 9,41,45,56,75,81 The major reason for this is that the arteriotomy and repair are centered such that the operative field is less crowded, and concern about iatrogenic stenosis is essentially eliminated. This makes the suturing easier and more comfortable for the surgeon.…”

Section: Clamp Times and Cerebral Ischemiamentioning

confidence: 99%

Techniques in carotid artery surgery

Curtis

Johansen²

2008

FOC

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✓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.

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Durability of eversion carotid endarterectomy: Comparison with primary closure and carotid patch angioplasty

Cited by 65 publications

References 28 publications

Awake Carotid Endarterectomy in Patients Undergoing Cardiac Surgery: Our 6 Years of Experience

Awake Carotid Endarterectomy in Patients Undergoing Cardiac Surgery: Our 6 Years of Experience

Multicenter Experience on Eversion Versus Conventional Carotid Endarterectomy in Symptomatic Carotid Artery Stenosis

Techniques in carotid artery surgery

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