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[Late results after eversion endarterectomy of the internal carotid artery]
1Semmelweis Egyetem Altalános Orvostudományi Kar, Er- és Szívsebészeti Klinika, 1122 Budapest, Városmajor utca 68. entz@freestart.hu
Insights
The eversion endarterectomy procedure for internal carotid artery stenosis shows a low long-term restenosis rate of 9% over 5 years. This surgical technique is effective and encouraging for managing carotid artery disease.
Area of Science:
- Vascular Surgery
- Cardiovascular Research
- Medical Technology Assessment
Context:
- Eversion endarterectomy introduced in Hungary in 1991 for internal carotid artery (ICA) stenosis.
- Need to evaluate long-term outcomes of this relatively new surgical approach.
- Limited data on restenosis rates following ICA eversion endarterectomy.
Purpose:
- To determine the long-term restenosis rate after eversion endarterectomy of the ICA.
- To assess patient survival and patency rates associated with the procedure.
- To investigate plaque morphology and its role in restenosis.
Summary:
- 171 ICA eversion endarterectomies performed between 1991-1993 on 151 patients.
- 109 patients completed long-term follow-up with annual physical and ultrasound examinations.
- 5-year restenosis rate >70% was 9%; 5-year survival 85%; 5-year recurrent stenosis-free rate 88%.
Impact:
- Perioperative stroke morbidity/mortality was 0.8%.
- Low restenosis rates suggest eversion endarterectomy is a viable option for ICA stenosis.
- Findings indicate atherosclerosis may not be a primary driver of restenosis post-eversion.
Objectives:
The eversion endarterectomy of the internal carotid artery was introduced in Hungary in 1991. The aim of this study was to define the long-term restenosis rate of this new method.
Materials And Methods:
Between 1991 and 1993, 171 operations were performed by one surgeon on 151 patients: 109 patients had enough compliance to take part in long-term follow-up, which included annual physical and ultrasound (Ultramark 9) investigations. Restenosis rate and plaque morphology was defined. Survival and patency rates were calculated by life-table method.
Results:
The perioperative combined stroke morbidity and mortality rate was 0.8%. The 5-year patient survival rate was 85%, the recurrent stenosis free rate was 88%/5 years, and 9% of the patients had restenosis greater than 70% in this period. The plaque morphology showed calcification in 1 case. Two patients needed 3 reoperations (2.4%). Plaque histology showed myointimal hyperplasia in every 3 cases.
Conclusions:
Comparing our results to the literature (2-34% restenosis rate) it seems to be acceptable and encouraging for the future. The ultrasound and histological findings suggest that arteriosclerosis does not play significant role in development of restenosis after the eversion method.