Carotid surgery without external carotid endarterectomy: a 6-year clinical experience with 1027 cases

previously we routinely performed endarterectomy of the external carotid artery (ECA) during carotid surgery. However, discouraging experience and lack of supportive data in the literature made us question its necessity. The present report describes our experience with a modified carotid endarterectomy (CEA) technique where the ECA is left undisturbed regardless of its degree of stenosis.

from January 1996 to June 2001, 1027 CEAs were performed in 905 patients with this technique at our institution. All operations were performed for at least 60% internal carotid artery (ICA) stenosis. A preoperative carotid duplex scan was available for review in 990 cases (96%). Follow-up duplex scans were recovered from 0 to 1 months in 851 cases (83%) and from >1 month in 655 cases (64%). Seventy percent of these cases were performed for asymptomatic lesions.

the perioperative (30-day) mortality rate for the entire group of patients was 0.5% and the stroke rate was 0.7%. Mean follow-up was 18 months (range: 2-66 months). Only two ECAs occluded in the first postoperative month. During the follow-up period, 37 additional ECAs (5.6%) were found to progress from mild to severe (>75%) stenosis postoperatively. In addition, 7% of the cases were found to have worsened the degree of stenosis, 8% improved and 85% remained unchanged.

these data support sparing of the ECA during CEA.