A comparison of outcomes of eversion versus conventional carotid endarterectomy: one centre experience

Prompt carotid endarterectomy for stroke prevention remains an essential component of treatment for symptomatic carotid stenosis. There exist a number of techniques, most commonly, access via a longitudinal arteriotomy for conventional carotid endarterectomy (CCEA), but eversion endarterectomy (ECEA) may also be used. Neither has been definitively proven as superior. We outline the experience in our institution of these two approaches.

All patients who had surgery over a 7-year period (2009-2015) under a single consultant vascular surgeon were included in this analysis. Midway through the study period, the operative technique was changed from exclusively CCEA to exclusively ECEA. Demographics, outcomes, and complications, including re-intervention and restenosis rate were gathered from a variety of sources to maximise data reliability and accuracy.

Two hundred four interventions were performed during the study period; 114 in the CCEA group, 90 in the ECEA group. Demographics and indication for surgery was well matched between groups. A significant difference was found between operative time (128.6 ± 2.3 vs 70.7 ± 12.2 min) and need for shunting (19.3% vs 1.9%), between CCEA and ECEA. Haematoma rates were higher in the ECEA group (7.7% vs 1.7%), but this can be attributed to differing use of perioperative anti-platelet therapy. There was no other statistical difference in morbidity, mortality, restenosis rates, or re-intervention rates between groups.

These two carotid endarterectomy techniques are equivalent in terms of outcome, but ECEA can be performed in a significantly shorter operative time and reduces need for shunting.