Eversion versus conventional carotid endarterectomy with patch angioplasty: Population-based cohort study

To compare in-hospital and long-term outcomes between conventional carotid endarterectomy with patch angioplasty (cCEA) and eversion carotid endarterectomy (eCEA).

Patients undergoing eCEA or cCEA from January 1, 2012, to December 31, 2024, were identified using the Vascular Quality Initiative database and included in the study. Inverse probability weighting was used to yield balanced study groups. Propensity-weighted logistic regression was used to compare binary outcomes and propensity-weighted Cox regression to compare all-cause mortality.

Overall, 157,729 patients undergoing cCEA and 22,296 patients undergoing eCEA were included in the study. eCEA was associated with lower odds of cranial nerve injury (adjusted odds ratio [aOR], 0.69; 95% confidence interval [CI], 0.66-0.73). This was consistent for injuries to cranial nerves VII, IX, X, and XII, as well as other cranial nerves. Similarly, eCEA had lower odds of in-hospital myocardial infarction (aOR, 0.71; 95% CI, 0.65-0.78) and long-term myocardial infarction (aOR, 0.92; 95% CI, 0.87-0.98) compared with cCEA. The odds of in-hospital stroke or transient ischemic attack (aOR, 1.06; 95% CI, 0.99-1.12) and long-term stroke or transient ischemic attack (aOR, 1.03; 95% CI, 0.98-1.07) were similar in both groups. However, the odds of in-hospital stroke (aOR, 0.89; 95% CI, 0.81-0.99) and long-term stroke (aOR, 0.92; 95% CI, 0.85-0.98) were lower for eCEA. All-cause mortality was similar in both groups (aOR, 1.05; 95% CI, 0.99-1.11). Patients who were younger, had a higher body mass index, underwent general anesthesia, and underwent surgery later in the study period were found to derive greater benefit from undergoing eCEA.

eCEA was associated with a lower odds of stroke, cranial nerve injury, and myocardial infarction, but similar all-cause mortality rates compared with cCEA. Given its superior effectiveness and safety, eCEA may be a better alternative to cCEA for the treatment of flow-limiting carotid disease.