Outcomes following Eversion versus Conventional Endarterectomy in the Vascular Quality Initiative Database

Area of Science:

• Vascular Surgery
• Cardiovascular Research
• Surgical Technique Comparison

Background:

• Carotid endarterectomy (CEA) is a common procedure to prevent stroke.
• Two main techniques exist: conventional CEA (c-CEA) and eversion CEA (e-CEA).
• The superiority of one CEA technique over the other remains debated.

Purpose of the Study:

• To compare the postoperative outcomes and long-term durability of c-CEA versus e-CEA.
• To analyze national data for a representative cohort comparison.
• To evaluate stroke, death, and restenosis rates for both surgical approaches.

Main Methods:

• Retrospective analysis of the Vascular Quality Initiative database (2003-2018).
• Inclusion of 95,726 CEA cases, excluding prior interventions and concomitant procedures.
• Multivariable logistic and Cox-regression analyses for risk-adjusted perioperative and 1-year outcomes.

Main Results:

• Eversion CEA (e-CEA) was used in 12.6% of cases; conventional CEA (c-CEA) in 87.4%.
• Patch angioplasty was more frequent in c-CEA (94.9%) than e-CEA (49.7%).
• No significant difference in outcomes when c-CEA used patch angioplasty; e-CEA showed lower 30-day and 1-year stroke/death rates when no patching was used in either procedure.

Conclusions:

• Both c-CEA (with patch angioplasty) and e-CEA are safe and durable CEA techniques.
• Eversion CEA demonstrates superior outcomes compared to c-CEA without patch angioplasty.
• Eversion CEA is associated with a significant reduction in 30-day and 1-year stroke/death rates.