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Eversion carotid endarterectomy: a technical alternative that may obviate patch closure in women
R Clement Darling1, Manish Mehta, Sean P Roddy
1Institute for Vascular Health and Disease, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA. DarlinC@mail.amc.edu
Cardiovascular Surgery (London, England)
|September 6, 2003
Summary
Eversion carotid endarterectomy (e-CEA) shows a low restenosis rate in women. This technique may offer improved durability compared to standard CEA, reducing the need for reintervention.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease
- Surgical Outcomes
Background:
- Recurrent carotid stenosis after standard carotid endarterectomy (s-CEA) impacts long-term procedure durability and may necessitate reintervention.
- Eversion carotid endarterectomy (e-CEA) is an alternative surgical technique for carotid stenosis.
Purpose of the Study:
- To evaluate the incidence of restenosis following eversion carotid endarterectomy (e-CEA) specifically in female patients.
- To compare the durability of e-CEA with s-CEA in preventing recurrent carotid stenosis.
Main Methods:
- A retrospective review of elective carotid endarterectomy (CEA) cases performed between July 1994 and June 1999.
- Eversion carotid endarterectomy (e-CEA) was the preferred technique, often performed under regional anesthesia in awake patients.
- Postoperative duplex scans at 3, 6, 12 months, and annually thereafter, with significant restenosis (>70%) confirmed by angiography.
Main Results:
- A total of 3429 e-CEAs were performed; 15 (1.5%) female patients developed significant restenosis (>70%).
- Stroke and operative mortality rates were low and comparable between sexes (0.8% stroke, 0.5% mortality in females).
- Complication rates such as cranial nerve injury and wound infection were also low in female patients.
Conclusions:
- Eversion carotid endarterectomy (e-CEA) demonstrates a low incidence of restenosis in women.
- The e-CEA technique, involving transection and anastomosis at the carotid bulb, avoids distal artery narrowing and patch-related risks.
- This straightforward e-CEA approach appears to enhance the durability of carotid endarterectomy in female patients.