Early hemodynamic characteristics of eversion and patch carotid endarterectomies

Area of Science:

• Vascular Surgery
• Cardiovascular Hemodynamics
• Medical Device Technology

Background:

• Carotid endarterectomy (CEA) is the standard surgical treatment for carotid artery stenosis.
• Eversion and patch CEA are common techniques, with studies showing similar clinical outcomes.
• Early hemodynamic differences between eversion and patch CEA techniques remain largely unknown.

Purpose of the Study:

• To investigate and compare early hemodynamic differences between eversion and patch carotid endarterectomy (CEA).
• To assess post-operative peak systolic velocities (PSV) in the internal carotid artery (ICA) and common carotid artery (CCA) following both procedures.

Main Methods:

• Retrospective analysis of 171 carotid endarterectomies (CEA) performed between March 2012 and June 2018.
• Data collected included patient demographics, procedure type, and pre- and post-operative duplex ultrasound (DUS) findings.
• Exclusion criteria included incomplete data, DUS >90 days post-op, concomitant bypass, isolated external carotid artery (ECA) endarterectomies, and re-do CEAs.

Main Results:

• 27 eversion and 81 patch CEAs were analyzed; patient demographics and laterality were similar, though eversion patients were older.
• Pre-operative peak systolic velocities (PSV) in the proximal ICA, distal ICA, and distal CCA were comparable between groups.
• Post-operative PSV and the change in PSV were not significantly different between eversion and patch CEA cohorts for any analyzed arterial segment.

Conclusions:

• Despite technical variations, eversion and patch CEA techniques result in similar early post-operative hemodynamics.
• No significant differences in post-operative PSV or PSV change were observed around the carotid bifurcation.
• These findings suggest comparable hemodynamic performance between the two CEA methods in the early post-operative period.