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Eversion carotid endarterectomy without shunt: concerning 1385 consecutive cases.

Sabrina Ben Ahmed¹, Guillaume Daniel¹, Marie Benezit¹

¹Department of Vascular Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France.

The Journal of Cardiovascular Surgery

|February 13, 2015

Summary

Eversion carotid endarterectomy (e-CEA) without shunts is safe and effective. This study shows a low stroke and death rate, demonstrating e-CEA as a reliable routine procedure.

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Published on: October 4, 2021

Area of Science:

Vascular Surgery
Cerebrovascular Surgery
Surgical Outcomes

Background:

Carotid stenosis poses a significant risk of stroke.
Traditional carotid endarterectomy (CEA) often requires intra-arterial shunts.
Evaluating alternatives to shunt placement is crucial for improving surgical outcomes.

Purpose of the Study:

To assess the perioperative safety and efficacy of eversion carotid endarterectomy (e-CEA) performed without shunts.
To determine the feasibility of e-CEA as a routine surgical technique.
To evaluate the 30-day perioperative results of e-CEA without shunt placement.

Main Methods:

A retrospective analysis of 1385 e-CEAs performed between 2004 and 2013.
Patients presented with hemispheric, ocular, or oculopyramidal symptoms of carotid stenosis.
Intra-arterial shunt use was determined by assessing retrograde internal carotid artery (ICA) pressure and back-bleeding, with blood pressure augmentation if needed.

Main Results:

100% freedom from intra-arterial shunt placement was achieved by managing arterial perfusion.
The overall stroke and death rate was 1.3% (9 deaths, 24 non-fatal neurologic events).
Nine patients (0.7%) died perioperatively, and 24 (1.7%) experienced non-fatal neurologic events.

Conclusions:

Eversion carotid endarterectomy (e-CEA) can be safely performed as a routine procedure.
Surgeon's assessment of arterial back-bleeding guides shuntless e-CEA.
This technique is cost-effective and reduces the need for shunts and cerebral perfusion monitoring adjuncts.