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

Abstract

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.

Factors affecting operative time and outcome of carotid endarterectomy in the Vascular Quality Initiative

“…Reports indicate that duplex ultrasound will result in revision of the endarterectomy in 2.3% of cases, but no studies have shown that this increases the technical success of a CEA. 13 Similarly, in the Stent-Protected Angioplasty vs Carotid Endarterectomy (SPACE-1) trial, eversion rather than patch angioplasty was not shown to be associated with worse long-term outcomes 14 and saved 16 minutes of Op time compared with using a patch in our model. Therefore, in a patient with cardiac disease, a surgeon could consider specific techniques to shorten the procedure and potentially to reduce cardiac MAEs.…”

Comparison of Results Classical and Eversion Carotid Endarterectomy

“…Research Demirel and associates as advantages C-CEA informing about a greater 30 day risk of both stroke and death in patients treated with E-CEA technique (9% vs. 3%, p = 0.005) (8), unlike the other speaking the significantly lower morbidity and mortality (1.35% vs. 4%, p <0.005) (16) and a smaller number of CVI (0.9% vs. 2.9%, p <0.01) and mortality 1.8%, compared to 0.54%, P <0.05 (17), in a patient operated E-CEA technique. In contrast to these, some studies have recorded a statistically significant difference in the incidence of postoperative ICV and death in patients operated with these two operating techniques.…”

“…The potential advantage of E-CEA is the fact that placing the patch at the same it is not necessary (8, 9, 10). …”

Immediate and long-term outcomes of carotid bifurcation remodeling

“…По данным исследований, несмотря на хорошие отдаленные результаты после эверсионной КЭ, частота периоперационных инсультов при данной методике встречается чаще, чем при выполнении классической КЭ [20,21]. Это обусловлено трудностями адекватной эндартерэктомии, риском расслоения интимы с развитием тромбоза сонной артерии, сложностями установки шунта при протяженном поражении ВСА [20,22].…”