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Durability of eversion carotid endarterectomy
Enzo Ballotta1, Antonio Toniato1, Giuseppe Da Giau1
1Vascular Surgery Group, 2nd Surgical Clinic, Department of Surgical, Oncological, and Gastroenterological Sciences at the University of Padua, School of Medicine, Padova, Italy.
Insights
Eversion carotid endarterectomy (CEA) offers excellent long-term protection against stroke and carotid restenosis. This study confirms CEA
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Carotid endarterectomy (CEA) is a standard treatment for carotid artery disease.
- Carotid angioplasty and stenting is a viable alternative.
- Durability of CEA requires long-term assessment.
Purpose of the Study:
- To evaluate the long-term durability of eversion CEA.
- To assess stroke and restenosis rates after CEA.
Main Methods:
- Prospective follow-up of 1773 patients undergoing 2007 primary eversion CEAs (1990-2012).
- Mean follow-up of 12.9 years.
- Clinical and ultrasonographic monitoring for perioperative and late outcomes.
Main Results:
- Perioperative stroke rate was 0.4% with no deaths.
- Late restenosis/occlusion incidence was negligible (0.52%).
- Late ipsilateral stroke rate was 0.47%, unrelated to restenosis.
Conclusions:
- Eversion CEA provides excellent protection against cerebral ischemia.
- The procedure has an extremely low perioperative stroke/death risk.
- Late restenosis/occlusion rates are negligible, ensuring sustained benefit.
Objective:
Carotid endarterectomy (CEA) remains the gold standard for treating carotid disease in selected symptomatic and asymptomatic patients, though carotid angioplasty and stenting has emerged as a safe alternative. The aim of this study was to assess the durability of CEA in a large series of patients followed up according to a strict clinical and ultrasonographic protocol.
Methods:
Over a 23-year period (1990-2012) a total of 1773 patients (1251 men and 522 women) with a mean age of 75.2 years (range, 31 to 96 years) who underwent 2007 consecutive primary eversion CEAs performed by the same surgeon under general anesthesia with electroencephalographic monitoring and selective shunting were prospectively followed up with ultrasonography at 1, 6, and 12 months, then yearly. A long-term follow-up (median, 11.2 years; mean, 12.9 years) was obtained for 1680 patients (94.8%). End points were perioperative (30-day) stroke and death and late carotid restenosis/occlusion rates.
Results:
More than two in three of the lesions (1446 of 2007, 72.1%) were symptomatic at the time of surgery, with a 25% rate of preoperative stroke. Preoperative antiplatelet or anticoagulant therapy was used by 1675 patients (94.4%), whereas 918 (51.8%) were receiving statin treatment. Overall, there were eight (0.4%) perioperative strokes and no deaths. During the follow-up, there were nine (0.47%) asymptomatic late carotid restenoses (six moderate [50%-69%] and three severe [≥ 70%]) and one (0.05%) carotid occlusion. Nine patients (0.47%) had late ipsilateral strokes, none of them related to restenosis/occlusion. Overall, there were 159 late deaths (9.4%).
Conclusions:
The results of this study show that eversion CEA can be performed in symptomatic and asymptomatic patients with an extremely low perioperative stroke/death risk and a negligible incidence of late restenosis/occlusion, thus assuring a persistently good protection against the risk of cerebral ischemia.
