[Minimally invasive carotid artery surgery]

Area of Science:

• Vascular Surgery
• Surgical Approaches
• Patient Outcomes

Background:

• Carotid endarterectomy (CEAE) is a procedure to remove plaque from carotid arteries.
• Choosing the optimal surgical approach is crucial for patient recovery and satisfaction.
• Existing methods offer varying cosmetic and functional outcomes.

Purpose of the Study:

• To establish criteria for selecting the optimal surgical approach for CEAE.
• To compare the effectiveness of CEAE using three distinct surgical access methods.
• To evaluate neurological complications, cosmetic results, and quality of life post-procedure.

Main Methods:

• A study involving 120 patients undergoing CEAE via three approaches: classical longitudinal access, natural skin fold (NSF) mini-access, and NSF extended access.
• Ultrasound was used for intraoperative visualization of the carotid artery bifurcation and plaque.
• Effectiveness was assessed by neurological complications, cosmetic outcomes, and quality of life at 1 and 12 months post-surgery.

Main Results:

• No strokes or transient ischemic attacks were observed within one month across all groups.
• After 12 months, Group II (classical access) experienced 2 strokes and 8 cases of cranial neuropathy.
• Subgroup IA (NSF mini-access) demonstrated the best cosmetic results and highest physical and mental health scores.

Conclusions:

• The natural skin fold (NSF) approach, especially mini-access, offers superior cosmetic and quality-of-life benefits for CEAE.
• Classical longitudinal access is associated with higher risks of stroke and neuropathy post-CEAE.
• A personalized computer program was developed to aid in selecting the optimal surgical approach for CEAE.