Management of the external carotid artery during routine carotid endarterectomy

This study analyzes the results of carotid endarterectomy with a uniform technique of external carotid artery management. Aggressive blind instrument and eversion endarterectomy of the distal external carotid and its branches above the superior thyroid artery was performed during 211 standard carotid endarterectomies. This technique allows isolated external carotid artery repair if necessary after re-establishing carotid blood flow. Of these, 196 (92.9%) had normal intraoperative continuous wave Doppler ultrasonography in the external carotid. The 15 (7.1%) abnormal external carotid arteries underwent isolated completion endarterectomy with or without patch reconstruction followed by a normal Doppler study. All 15 had normal external carotid artery duplex ultrasonography 3 to 6 months after endarterectomy. However, 2 of the 196 (1.04%) intraoperative ultrasound normal external carotids had significant residual or recurrent stenosis (no occlusions) 3 to 6 months after endarterectomy for an early external carotid residual or restenosis rate of 0.95% (2/211). This was significantly less (p less than 0.05) than the 5.2% (11/211) 3- to 6-month incidence of residual or recurrent external carotid stenosis (6) and occlusion (5) in 211 carotid endarterectomies in which the external carotid artery was managed in an arbitrary manner. This study supports aggressive eversion endarterectomy of the external carotid artery during standard carotid endarterectomy with isolated repair when indicated.