High Cervical Carotid Endarterectomy-Outcome Analysis

Area of Science:

• Vascular Surgery
• Cerebrovascular Disease
• Surgical Technique

Background:

• Carotid endarterectomy (CEA) for high cervical internal carotid artery stenosis presents technical challenges due to distal dissection difficulties.
• Effective surgical strategies are needed to improve outcomes for these complex cases.

Purpose of the Study:

• To report a specific surgical technique for CEA in high cervical lesions.
• To analyze the surgical outcomes and identify risk factors for complications in these patients.

Main Methods:

• Retrospective analysis of 98 patients undergoing CEA between December 2013 and June 2018.
• Definition of high cervical lesions as plaque rostral to the C2 vertebral level (n=34).
• Detailed description of surgical steps including incision extension, nerve exposure, and anatomical structure retraction.

Main Results:

• Surgical outcomes for high cervical lesions were equivalent to non-high cervical lesions.
• No significant difference in technique-related or perioperative-related cerebral infarction (PRCI) between high and non-high cervical groups.
• Postoperative diastolic blood pressure changes identified as a risk factor for PRCI (P=0.033).

Conclusions:

• CEA for high cervical lesions can achieve outcomes similar to those for non-high cervical lesions.
• Prudent blood pressure management in the early postoperative period is essential to mitigate the risk of PRCI.