[Open carotid endarterectomy: the classical operation method, experimental carotid stenting]

In a retrospective study we examined the possible of obtaining better results with a new operation technique of the carotid artery, the so-called "no-touch isolation" in comparison with conventional operation technique.

49 patients, who had been operated in 1997 and 1998 by this new operation technique, were compared with a group of 39 patients, who had been previously operated with the conventional technique. The new "no-touch isolation" technique is aimed at avoiding possible intraoperative and postoperative embolies. First, the carotis internal artery was exposed and clamped distal to the stenotic plaque very atraumatically. The operation was further carried out without the use of an intraluminal shunt. At the end of the procedure the operation results were checked by means of an intraoperative angiography. In case of a possible embolization source, like pieces of intima, an intraoperative revision was carried out until all embolization material was removed.

The two compared groups were not different regarding age, sex, symptomatology, degree of stenosis, and risk factors. No significant differences in context with the applied operation method for TEA (with or without patch, Eversions-TEA, etc.) could be detected. The group operated with the "no-touch isolation" technique had significantly longer operationtimes and also significantly longer clampingtimes than the group operated with the conventional technique. However, the postoperative results were better. Significantly fewer neurological deficits appeared and, in addition significantly fewer patients had to be revised because of secondary hemorrhages.

The "no-touch isolation" technique is, at the moment, the best surgical procedure for the carotid artery. It is the method of choice for patients with symptomatic stenosis of the internal carotid artery with more than 70% stenotic degree.