Early postoperative outcome after carotid artery endarterectomy with bifurcation advancement

Background: The aim of this study is to review the single center experience in surgical treatment of carotid artery disease (CAD) using bifurcation advancement carotid endarterectomy (BA-CEA) and compare the in-hospital outcome with one of the largest nationwide carotid endarterectomy (CEA) databases worldwide, the German statutory quality assurance database (GD). Patients and methods: Data of BA-CEA procedures in the period of 2006-2015 were analyzed retrospectively. The primary endpoint was defined as combined stroke and death rate. Secondarily, isolated stroke, TIA, patient death, myocardial infarction, major neck hematoma and cranial nerve injuries were analyzed. Symptomatic and asymptomatic CAD patients were divided into two subgroups. The results were compared to extracted published data from the German database (GD). Results: Of 239 included BA-CEA procedures 188 (78.7%) procedures were carried out in patients with symptomatic carotid artery stenosis. The overall perioperative combined stroke and death rate after BA-CEA was 2.5%. Five (2.1%) patients suffered from a stroke (one minor and four major strokes), of which two hemorrhagic strokes ended fatally. Overall, four (1.7%) patients died perioperatively. The combined stroke and death rate was higher in the symptomatic subgroup (3.2%; 0% in the asymptomatic group). No significant differences were found between the results of BA-CEA and the German database (n=142'074) for combined stroke and death rates and isolated stroke. Significant differences were found among the overall mortality rate (BA-CEA: 1.7% vs. GD: 0.6, p=0.04). The risk of postoperative cranial nerve injuries was also significantly higher after BA-CEA overall (BA-CEA: 5.0% vs. GD: 1.2%, p=<0.0001), in symptomatic CAD patients (BA-CEA: 4.8% vs. GD: 1.2%, p=<0.0001) and in asymptomatic CAD patients (BA-CEA: 5.9% vs. GD: 1.3%, p=0.01). Conclusions: CEA with bifurcation advancement provides comparable perioperative results, focusing on combined stroke and mortality, but seems to have some technical drawbacks, which may lead to more frequent local neurological complications.