[Long-term results conventional and eversion carotid endarterectomy]

Area of Science:

• Vascular Surgery
• Cerebrovascular Disease Management
• Surgical Technique Comparison

Background:

• Carotid endarterectomy (CEA) is a crucial procedure for preventing stroke.
• Both conventional and eversion CEA techniques are employed, with varying reported outcomes.
• A comprehensive analysis of immediate and long-term results is essential for optimizing patient care.

Purpose of the Study:

• To compare the immediate and long-term outcomes of conventional versus eversion carotid endarterectomy (CEA).
• To analyze complication rates, including stroke and restenosis, between the two CEA techniques.
• To evaluate the long-term efficacy of eversion CEA in preventing internal carotid artery (ICA) restenosis.

Main Methods:

• A retrospective, multi-center study involving 375 patients undergoing CEA between February 2018 and February 2022.
• Patients were stratified into eversion CEA (n=218) and conventional CEA with patch plasty (n=157) groups.
• Long-term follow-up (26.5±18.3 months) included telephone interviews and clinic examinations.

Main Results:

• No significant difference in acute cerebrovascular accident (stroke) frequency was observed between groups.
• Eversion CEA demonstrated a significantly lower incidence of late stroke (0.91% vs. 3.8%, p=0.05).
• Conventional CEA showed a higher rate of significant ICA restenosis (>60%) compared to eversion CEA (7.0% vs. 0%, p<0.0001).

Conclusions:

• Eversion CEA is associated with a reduced risk of hemodynamically significant ICA restenosis in the long term.
• While eversion CEA shows promise, further randomized multicenter trials are necessary to establish definitive evidence of its superiority.
• Results from such trials are needed for inclusion in clinical guidelines to guide CEA technique selection.