Carotid bifurcation reconstruction as a novel CEA modification to address complex carotid lesions

To evaluate the feasibility and short-term outcomes of carotid bifurcation reconstruction, a modified carotid endarterectomy (CEA) technique for complex carotid lesions, by comparing it with conventional CEA with patch angioplasty.

A retrospective cohort study was conducted on patients who underwent carotid revascularization at our institution between September 2023 and November 2025. Patients receiving carotid bifurcation reconstruction surgery were assigned to the observation group (n = 21), and those receiving conventional CEA with patch angioplasty during the same period were assigned to the control group (n = 33). All procedures were performed by a single senior vascular surgeon. Baseline characteristics, preoperative imaging findings, intraoperative parameters, postoperative complications and follow-up data were collected and compared between the two groups.

A total of 54 patients were enrolled, with no significant differences in baseline demographic and clinical characteristics between the two groups (all P > 0.05). The median follow-up duration was 14 months (IQR 6-21 months) in the observation group and 16 months (IQR 8-23 months) in the control group, with no significant between-group difference (P = 0.4025) and no patient lost to follow-up. For the overall cohort, no significant between-group differences were found in total operative time (P = 0.106) and intraoperative shunt use rate (P = 0.083), while the observation group had significantly less intraoperative blood loss [100 (50, 100) mL vs. 120 (100, 155) mL, P = 0.008]. In patients without intraoperative shunt placement, the carotid cross-clamp time was significantly shorter in the observation group than in the control group (22.4 ± 4.1 min vs. 25.5 ± 3.4 min, P = 0.032). The observation group had a shorter postoperative hospital stay [5.0 (5.0, 6.0) d vs. 6.0 (5.0, 8.0) d, P = 0.005]. No major perioperative complications occurred in either group, and all observed adverse events were transient and resolved before discharge. During follow-up, no ipsilateral ischemic stroke or significant carotid restenosis (≥ 50%) was detected in either group.

Carotid bifurcation reconstruction may be a feasible modified CEA technique for selected patients with complex carotid lesions.