Objective: To compare the results of the use of modified eversion carotid endarterectomy with standard eversion carotid endarterectomy in patients with common atherosclerotic lesion of internal carotid artery.
Material and methods. The study is based on the analysis of treatment results for 126 patients with chronic cerebrovascular insufficiency due to widespread atherosclerotic lesions of the internal carotid artery (ICA) who underwent reconstructive surgery for bifurcation of the common carotid artery: eversion carotid endarterectomy (group 1) and modified eversion carotid endarterectomy (group 2). The presence of an atherosclerotic plaque extending to a distance of more than 2.5 cm from the bifurcation was considered a common lesion of the internal carotid artery. The assessment of intraoperative parameters, the early postoperative period, as well as the treatment results after 3, 6 and 12 months from the time of surgery.
Results. The results of treatment of 126 patients in two surgical groups in the early postoperative and long-term periods were analyzed. The average operation time was 72.04 ± 8.23 minutes. The average ICA clamping time was 19.13 ± 3.8 minutes. When analyzing the ICA clamping time between groups, significant differences were revealed (p = 0.032). A transient ischemic attack (TIA) in the early postoperative period occurred in 7 (5.5%) patients. In group 1, TIA was recorded in 6 (9.1%) patients, and in group 2 in 1 (1.7%) patients, with no significant differences. When analyzing the total risk indicator for stroke and TIA, we found statistically significant results in favor of a modified method: 7 (10.6%) versus 1 (1.7%) in groups 1 and 2, respectively (OR 0.14, 95% CI 0.017–1.97; p = 0.04). Restenosis of the internal carotid artery (≥ 40%) on the side of the performed reconstruction in group 1 developed in 11 (17.5%) patients, and in group 2 in 3 (5.2%) patients (p = 0.035).
Conclusion. The risk of developing neurological disorders in the early postoperative period, as well as restenosis of the surgical area in the long term, using the modified method of eversion carotid endarterectomy is significantly lower than after the standard method.
- Gusev E.I., Skvorcova V.I., Stahovskaja L.V., Kilikovskij V.V., Ajrijan N.Ju. Epidemiology of stroke in Russia. Materials of the 1st Russian International Congress "Cerebrovascular Pathology and Stroke". S.S. Korsakov Journal of Neurology and Psychiatry. 2003; 103 (S9): 114 (in Russ.).
- Savel'ev V.S. (Ed.). 50 lectures on surgery. Moscow: TriadaH; 2004: 68–84 (in Russ.).
- Kuznetsov A.N. Modern principles of treatment of multifocal atherosclerosis. Bulletin of the National Medical and Surgical Center. 2008; 3 (1): 78–83 (in Russ.).
- Naylor A.R., Ricco J.B., De Borst G.J., Debus S., De Haro J., Halliday A. et al. Management of atherosclerotic carotid and vertebral artery disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur. J. Vasc. Endovasc. Surg. 2018; 55 (1): 3–81. DOI: 10.1016/j.ejvs.2017.06.021
- Demirel S., Bruijnen H., Attigah N., Hakimi M., Böckler D. The effect of eversion and conventional-patch technique in carotid surgery on postoperative hypertension. J. Vasc. Surg. 2011; 54 (1): 80–6. DOI: 10.1016/j.jvs.2010.11.106
- Markovic D.M., Davidovic L.B., Cvetkovic D.D., Maksimovic Z.V., Markovic D.Z., Jadranin D.B. Single-center prospective, randomized analysis of conventional and eversion carotid endarterectomy. J. Cardiovasc. Surg. 2008; 49 (2): 619–25.
- Radak D., Ilijevski N., Djukic N. Carotid surgery today: an update after 14,000 carotid endarterectomy procedures. Vojnosanit. Pregl. 2016; 73 (5): 472–9. DOI: 10.2298/vsp 160305060r
- Antonopoulos C.N., Kakisis J.D., Sergentanis T.N., Liapis C.D. Eversion versus conventional carotid endarterectomy: a meta-analysis of randomized and non-randomized studies. Eur. J. Vasc. Endovasc. Surg. 2011; 42 (6): 751–65. DOI: 10.1016/j.ejvs.2011.08.012
- Balzer K., Guds I., Heger J., Jahnel B. Conventional thrombendarterectomy with carotid patch plasty vs. eversion endarterectomy: technique, indications and results. Zentralbl. Chir. 2000; 125 (3): 228–38.
- Littoy F.N., Gagovic V., Sandu C., Mansour A., Kang S., Greisler H.P. Comparison of standard carotid endarterectomy with dacron patch angioplasty versus eversion carotid endarterectomy during 4-year period. Am. Surg. 2004; 70 (2): 181–5.
- DeBakey M.E., Crawford E.S., Cooley D.A., Morris C.G. Surgical considerations of occlusive disease of innominate, carotid, subclavian and vertebral arteries. Ann. Surg. 1959; 149 (5): 690–710. DOI: 10.1097/00000658-195905000-00010
- Jones C.E. Carotid eversion endarterectomy revisited. Am. J. Surg. 1989; 157 (3): 323–8. DOI: 10.1016/0002-9610(89)90562-x
- Kieny R., Hirsch D., Seiller C., Thiranos J.C., Petit H. Does carotid eversion endarterectomy and reimplantation reduce the risk of restenosis? Ann. Vasc. Surg. 1993; 7 (5): 407–13. DOI: 10.1007/BF02002123
- Raithel D. Carotid eversion endarterectomy: a better technique than the standard operation? Cardiovasc. Surg. 1997; 5 (5): 471–2. DOI: 10.1016/s0967-2109(97)00034-3
- Ballota E., Renon L., Da Giau G., Toniato A., Baracchini C., Abbruzzese E. et al. A prospective randomozed study on bilateral carotid endarterectommy: patching versus eversion. Ann. Surg. 2000; 232 (1): 119–22. DOI: 10.1097/00000658-200007000-00017
- Cao P.G., De Rango P., Zannetti S. Eversion vs conventional carotid endarterectomy: a systemic review. Eur. J. Vasc. Endovasc. Surg. 2002; 23 (3): 195–201. DOI: 10.1053/ejvs. 2001.1560
- Crawford R.S., Chung T.K., Hodgman T., Pedraza J.D., Corey M., Cambria R.P. Restenosis after eversion vs. patch closure carotid endarterectomy. J. Vasc. Surg. 2007; 46 (1): 41–8. DOI: 10.1016/j.jvs.2007.02.055
- Stewart G., Ross-Russell R.W., Browse N.L. The long-term results of carotid endarterectomy for transient ischemic attacks. J. Vasc. Surg. 1986; 4 (6): 600–5. DOI: 10.1067/mva.1986.avs0040600
- Ringleb P.A., Bousser M.G., Ford G., Bath P., Brainin M., Caso V. et al. ESO-guidelines for management of ischaemic stroke. Cerebrovasc. Dis. 2008; 25 (5): 457–507. DOI: 10.1159/000131083
- Rubin J.R., Goldstone J., McIntyre K.E. Jr, Malone J.M., Bernhard V.M. The value of carotid endarterectomy in reducing the morbidity and mortality of recurrent stroke. J. Vasc. Surg. 1986; 4 (5): 443–9.
- DeGroote R.D., Lynch T.G., Jamil Z., Hobson R.W. Carotid restenosis: lon
About the authors
- Vladislav A. Panfilov, Cardiovascular Surgeon, ORCID
- Anatoliy O. Virganskiy, Dr. Med. Sc., Professor of Chair of Faculty Surgery No. 1
- Konstantin V. Romanenko, Head of Department of Vascular Surgery, ORCID