[Mini incisional eversion carotid endarterectomy to minimize embolic complications: the Jikei method]

Carotid endarterectomy (CEA) remains the gold standard for the treatment of carotid artery stenosis even after the approval of carotid artery stenting in Japan. At Jikei University, we have developed a mini incisional eversion CEA that has distinct advantages compared with conventional CEA. First, cerebral infarction has not occurred after this procedure in 70 patients, and therefore the risk of cerebral infarction appears to be lower than after conventional CEA. This is because the internal carotid artery (ICA) is dissected only after clamping of the common and external carotid arteries, thereby arresting the prograde flow that carries emboli to the brain. Second, the duration of ICA clamping is shorter because the anastomosis can be performed in an end-to-side manner without delicate closure, with or without patching. Finally, this eversion CEA requires only a 3-cm incision as compared with conventional CEA that usually requires an approximately 10-cm incision. This Jikei method is extremely minimally invasive with negligible embolic complications, and therefore we believe that this method should become the first-line treatment for most patients with carotid artery stenosis.