Related Experiment Video
Updated: Dec 20, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Long-term Durability and Safety of Carotid Endarterectomy Closure Techniques
Petroula Nana1, Konstantinos Spanos2, Gabriele Piffaretti3
1Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41110, Larissa, Greece. petr.nana7@hotmail.com.
Insights
Carotid endarterectomy techniques showed similar long-term outcomes for cerebrovascular events and restenosis. However, the eversion technique (ET) was linked to higher mortality and major adverse cardiac events (MACE).
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease Management
- Surgical Technique Comparison
Background:
- Carotid endarterectomy (CEA) is performed using primary closure (PC), patch closure (CP), or eversion technique (ET).
- The comparative long-term efficacy of these CEA techniques remains unclear.
Purpose of the Study:
- To compare the long-term outcomes of PC, CP, and ET in carotid endarterectomy.
- Outcomes assessed include cerebrovascular events (CVE), restenosis, survival, and major adverse cardiac events (MACE).
Main Methods:
- Retrospective analysis of prospectively recorded data from 1,357 patients across three European centers (2007-2018).
- Kaplan-Meier analysis was used to estimate freedom from CVE, restenosis (>70%), survival, and MACE.
- Patient demographics, comorbidities, and medical treatments were analyzed.
Main Results:
- No significant differences in freedom from CVE or restenosis were observed among PC, CP, and ET groups.
- The eversion technique (ET) was associated with significantly higher mortality rates (P < 0.001).
- ET also showed a higher rate of major adverse cardiac events (MACE) (P < 0.001).
Conclusions:
- All carotid endarterectomy closure techniques yield excellent long-term outcomes.
- Low rates of MACE and adverse events were observed across all methods.
- The eversion technique warrants careful consideration due to increased mortality and MACE risks.
Background:
Various techniques have been used for the execution of carotid endarterectomy; primary (PC), patch closure (CP) and eversion technique (ET).The superiority of any of them is still unproven. The aim of this study was to compare the long-term outcomes of each technique in terms of cerebrovascular event (CVE), restenosis, survival and major cardiac event (MACE).
Methods:
Between 2007 and 2018, a retrospective analysis of prospectively recorded data from three European tertiary centers was undertaken including 1.357 patients. Demographics, comorbidities and medical treatment were analyzed in relation to long-term outcomes. Freedom from CVE, restenosis (> 70%), survival and MACE were estimated with Kaplan-Meier analysis curve.
Results:
The mean age was 69.5 ± 8 (72% males;79% asymptomatic). 472 (35%) were treated with PC, 504 (37%) with CP and 381 (28%) with ET. Differences among groups were observed in age (P < 0.001), gender (P < 0.01), hypertension (P = 0.01), dyslipidemia (P < 0.001) and statin treatment (P < 0.001). The mean follow-up was 4.7 ± 3 years (median: 5 years). Seventy-three patients presented a CVE during 8 years of follow-up. The freedom from CVE including all techniques was 96% (SE 0.6%), 93% (SE 1%) and 89% (SE 1.6%), at 2, 5 and 8 years of follow-up, respectively, with no difference between groups (P .289). Freedom from restenosis was at 96% (SE 0.7%) and 89% (SE 5%) at 5 and 10 years, respectively, for all methods without differences. ET was associated with a higher mortality rate (P < 0.001) and MACE rate (P < 0.001).
Conclusions:
Excellent outcomes were achieved with all types of closure techniques with low rates of MACE and other adverse events during long-term follow-up after CEA.
