Outcome of conventional and modified eversion carotid endarterectomy techniques in symptomatic and asymptomatic patients with significant carotid artery stenosis

BACKGROUND Carotid endarterectomy (CEA) has been used to treat symptomatic and asymptomatic carotid artery stenosis (CAS) patients with proven efficacy and safety. Two CEA techniques, conventional and eversion endarterectomy are well established but each has limitations. Modified eversion endarterectomy (MEE) is another technique that favors benefits from both techniques. Objectives: To evaluate the outcome of conventional and modified CEA technique in both symptomatic and asymptomatic patients with significant carotid stenosis. METHODS From January 2005 to January 2011, a retrospective study was carried out at Mercy University Hospital. Two hundred and eighty patients were admitted for CEA. From January 2005 to July 2007, conventional carotid endarterectomy (CCE) was used for all patients (N.=92). From July 2007, technique was changed to MEE (N.=188). Preoperative patients’ characteristics and indication of surgery were analyzed. Operative details were recorded. Immediate, early and late post-operative complications, ICU and hospital stay and death rates were assessed. RESULTS Postoperative transient ischemic attacks (TIA) rate was 2.5% in all patients. No statistical difference was found comparing cere-brovascular accidents (CVA) in both CCE and MEE techniques however the latter was associated with significantly less postoperative bleeding. MEE required significantly less shunt and patch use compared to CCE (P<0.01). Thirty-day postoperative strokes were recorded only in symptomatic group (2.14%). Total TIAs and strokes in 30 days postoperative were significantly associated with symptomatic group comparing to asymptomatic one (P=0.02). ICU and postoperative hospital stay were longer in symptomatic group. Other postoperative complications were analyzed in both groups with no statistical difference. Mortality rate was (1.4%). It was only registered in symptomatic group. CONCLUSIONS MEE is effective without compromising safety or outcome in treating both symptomatic and asymptomatic CAS with much less shunt and patch need and less postoperative bleeding. CEA in asymptomatic CAS patient group is safe and effective.