[Carotid endarterectomy using eversion. One year radiologic results]

A prospective study was done in 100 patients operated on for a stenosis of the carotid artery by the eversion endarterectomy method of Van Maele (section-eversion-anastomosis) between January 1994 and August 1995. Ten patients were operated on bilaterally (thus, 110 procedures). The distribution of the patients was as follows 81 males and 19 females, mean age 71 years. Clinically, 50 patients were asymptomatic, 44 stage I, 2 stage II and 4 stage III. Arteriography of these patients showed 42 stenoses greater than or equal to 90%, 56 stenoses between 70 and 90% and 12 ulcerated plaques (according to the ESCT measurement standards). Concerning the supra-aortic vessels, 24 lesions of the vertebral-subclavian branches and 21 lesions of the intra-cerebral vessels were observed. Five endarterectomies out of the 110 (5.4%) could not be performed by this eversion method because of the immediate poor technical result before angiography. At the end of the procedure digital angiography was performed for all the patients who underwent an eversion endarterectomy (105 cases). Six images of the internal carotid artery presenting stenoses less than 30% were observed at the level of the implantation site. Two narrow stenoses of the distal part of the endarterectomy made the interposition of a PTFE graft necessary in 20% of the cases, a secondary procedure was necessary after the peri-operative angiography 2 implantations of PTFE in the internal carotid artery, 8 additional endarterectomies of the external carotid artery, 11 infiltrations with Papaverine. The immediate post-operative results were 1 death after hemiplegia, 1 hemiplegia with sequelae (mortality/morbidity approximately 2%, i.e. 2/103 eversions), 3 regressive hemipareses. Angiographic follow-ups after 1 year were performed on 100 out of 110 operated carotid arteries. With regard to the internal carotid artery, 4 patients showed a stenosis less than 30%, 1 patient a 50% stenosis, 1 patient a pre-occlusive stenosis making an operation with the interposition of a PTFE graft necessary (restenosis rate after one year 2%). All the patients followed after one year remained asymptomatic. Eversion endarterectomy is possible for the majority of the atheromatous stenoses of the carotid artery (5.4% were not possible for technical reasons). We find this method not appropriate when a shunt must be placed. Immediate results are comparable to those of classical surgical endarterectomy with or without patching. The restenosis rate at 1 year in our series is 2%. This technique provides an excellent anatomic result by peri-operative angiography and can especially be adapted to stenoses with excess of length of the carotid artery.