Carotid surgery without external carotid endarterectomy: A 6-year clinical experience with 1027 cases

Purpose: previously we routinely performed endarterectomy of the external carotid artery (ECA) during carotid surgery. However, discouraging experience and lack of supportive data in the literature made us question its necessity. The present report describes our experience with a modified carotid en...

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Bibliographic Details
Published in:European journal of vascular and endovascular surgery 2003-05, Vol.25 (5), p.458-461
Main Authors: Ascher, E., Hingorani, A., Markevich, N., Schutzer, R., Yorkovich, W.R., Kallakuri, S., Tsemekhim, B.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Carotid Stenosis - diagnostic imaging
Carotid Stenosis - surgery
Endarterectomy, Carotid - methods
Female
Humans
Male
Middle Aged
Postoperative Complications
Survival Rate
Treatment Outcome
Ultrasonography
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Summary:Purpose: previously we routinely performed endarterectomy of the external carotid artery (ECA) during carotid surgery. However, discouraging experience and lack of supportive data in the literature made us question its necessity. The present report describes our experience with a modified carotid endarterectomy (CEA) technique where the ECA is left undisturbed regardless of its degree of stenosis. Methods: from January 1996 to June 2001, 1027 CEAs were performed in 905 patients with this technique at our institution. All operations were performed for at least 60% internal carotid artery (ICA) stenosis. A preoperative carotid duplex scan was available for review in 990 cases (96%). Follow-up duplex scans were recovered from 0 to 1 months in 851 cases (83%) and from >1 month in 655 cases (64%). Seventy percent of these cases were performed for asymptomatic lesions. Results: the perioperative (30-day) mortality rate for the entire group of patients was 0.5% and the stroke rate was 0.7%. Mean follow-up was 18 months (range: 2-66 months). Only two ECAs occluded in the first postoperative month. During the follow-up period, 37 additional ECAs (5.6%) were found to progress from mild to severe (>75%) stenosis post-operatively. In addition, 7% of the cases were found to have worsened the degree of stenosis, 8% improved and 85% remained unchanged. Conclusion: these data support sparing of the ECA during CEA. Eur J Vasc Endovasc Surg 25, 458-461 (2003)
ISSN:1078-5884
1532-2165
DOI:10.1053/ejvs.2002.1867