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Single center experience with modified eversion carotid endarterectomy.

Tze-Woei Tan1, Albert K Weyman, Siamak Barkhordarian

  • 1Brown University, Providence, RI, USA.

Annals of Vascular Surgery
|December 22, 2010
PubMed
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Modified eversion carotid endarterectomy (MECE) is a safe alternative to traditional patch closure carotid endarterectomy (PCEA), offering shorter clamping times and comparable restenosis rates. This technique simplifies the procedure and avoids the need for patch closure.

Area of Science:

  • Vascular Surgery
  • Cardiovascular Disease
  • Surgical Techniques

Background:

  • Transaortic endarterectomy is a known surgical revascularization method for atherosclerotic renovascular disease.
  • Modified eversion carotid endarterectomy (MECE) adapts this technique using a longitudinal arteriotomy, simplifying the procedure and avoiding patch closure.
  • MECE offers potential for easier conversion to traditional patch closure carotid endarterectomy (PCEA) if needed.

Purpose of the Study:

  • To compare the safety and efficacy of modified eversion carotid endarterectomy (MECE) against traditional patch closure carotid endarterectomy (PCEA).
  • To evaluate perioperative stroke, morbidity, mortality, and late restenosis rates between MECE and PCEA.

Main Methods:

  • A total of 223 carotid endarterectomies (CEAs) were performed by three vascular surgeons between July 2004 and December 2008.

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  • Outcomes included perioperative stroke, morbidity, mortality, and restenosis rates (moderate and severe) assessed at multiple follow-up intervals.
  • Data were analyzed using Student's t-test, with follow-up exceeding 12 months for all patients.

    • Main Results:

    • Intraoperative carotid cross-clamping time was significantly shorter for MECE (29.2 minutes) compared to PCEA (52.2 minutes).
    • Mortality (1.8%) and perioperative stroke (1.4%) rates were low and similar between groups; overall morbidity was 7.2%.
    • Late restenosis rates were comparable between MECE (8.4%) and PCEA (6.2%), with no significant difference (p = 0.55).

    Conclusions:

    • Modified eversion carotid endarterectomy (MECE) presents a safer alternative to conventional carotid endarterectomy.
    • MECE demonstrates a restenosis rate comparable to PCEA, with the added benefit of reduced clamping time.
    • The technique obviates the need for patch closure, potentially simplifying the surgical procedure.