Eversion carotid endarterectomy: evaluation of results after changing the operation technique

Česká verzia

Authors: Libor Janoušek; Tomáš Marada; Jaroslav Chlupáč; Květoslav Lipár; Peter Baláž; Slavomír Rokošný; Ivan Matia; Miloš Adamec
Authors place of work: Institut klinické a experimentální medicíny Praha, Klinika transplantační chirurgie
Published in the journal: Čas. Lék. čes. 2011; 150: 41-43
Category: Original Article

Summary

Background:
Stroke is the third most common cause of mortality, and carotid artery stenosis causes up to 30% of all ischemic strokes. Eversion CEA (ECEA) has been proposed as an acceptable alternative to the standard bifurcation endarterectomy in many patients. This study was designed to analyze the long-term durability of ECEA in symptomatic and asymptomatic patients. Data were retrospectively reviewed to determine the incidence of major adverse cardiovascular events (MACEs) within 30 days of surgery, late survival, and the incidence of restenosis.

Methods and results:
From January 1999 to June 2010, 344 ECEAs were performed on 324 patients (34% female, 38% symptomatic). The mean follow-up period was 30 months.

Conclusions:
MACEs occurred in 28 patients (8.6%). The overall incidence of stroke or death after ECEA was 1.7% and 0.9% at discharge. The overall incidence of stoke or death after CEA was 4.3% and 21% (14 strokes, 69 deaths, 8 of which were stroke-related). The overall occurrence of any restenosis (> 50%) after CEA was 4.3% (14 of 324 procedures).

Key words:
carotid endarterectomy, eversion, restenosis.

Zdroje

1. De Bakey ME, Crawford ES, Cooley DA, Morris GC, Jr. Surgical considerations of occlusive disease of innominate, carotid, subclavian, and vertebral arteries. Ann Surg 1959; 149: 690–710.

2. Cao PG, de Rango P, Zannetti S, Giordano G, Ricci S, Celani MG. Eversion versus conventional carotid endarterectomy for preventing stroke. Cochrane Database Syst Rev 2001: CD001921.

3. Black JH, 3rd, Ricotta JJ, Jones CE. Long-term results of eversion carotid endarterectomy. Ann Vasc Surg 24: 92–99.

4. Goodney PP, Nolan BW, Eldrup-Jorgensen J, Likosky DS, Cronenwett JL. Restenosis after carotid endarterectomy in a multicenter regional registry. J Vasc Surg 2010; 52(4): 897–904.

5. Janousek L, Adamec M, Tošenovský P, Hájek P. Srovnání everzní a klasické endarterektomie a. carotis interna. Čes a slov Neurol Neurochir 2003; 66/99: 203–205.

6. Paraskevas KI. Carotid artery stenting versus endarterectomy for carotid stenosis. Lancet 2010; 376: 327; author reply -8.

7. Eckstein HH, Ringleb P, Allenberg JR, et al. Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trial. Lancet Neurol 2008; 7: 893–902.

8. Mas JL, Trinquart L, Leys D, et al. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial: results up to 4 years from a randomised, multicentre trial. Lancet Neurol 2008; 7: 885–892.

9. Group GTC. General anaesthesia versus local anaesthesia for carotid surgery: a multicentre randomised controlled trial Lancet 2008; 372: 2132–2142.

10. Shah DM, Darling RC, 3rd, Chang BB, et al. Carotid endarterectomy by eversion technique: its safety and durability. Ann Surg 1998; 228: 471–478.

11. Cao P, De Rango P, Cieri E, Giordano G. Eversion versus conventional endarterectomy. Semin Vasc Surg 2004; 17: 236–242.

12. Cao P, Giordano G, De Rango P, Zannetti S, Chiesa R, Coppi G, Palombo D, Spartera C, Stancanelli V , Vecchiati E. and Collaborators of the EVEREST Study Group. A randomized study on eversion versus standard carotid endarterectomy. Study design and preliminary results: The Everest Trial. J Vasc Surg 1998; 27: 595–605.

13. Baan J, Jr., Thompson JM, Reul GJ, et al. Vessel wall and flow characteristics after carotid endarterectomy: eversion endarterectomy compared with Dacron patch plasty. Eur J Vasc Endovasc Surg 1997; 13: 583–591.

Štítky

Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental Hygienist

Článek Islet transplantation for treatment of type-1 diabetes mellitus

Článek Kidney transplantation at the Institute for Clinical and Experimental Medicine

Článek Long-term follow-up of the first 500 liver transplant recipients transplanted at the Institute for Clinical and Experimental Medicine in Prague

Článek Determination of liver triglycerides by 1H MR spectroscopy

Článek Liver transplantation in patients with portal vein thrombosis

Článek The influence of surgical complications on renal graft function

Článek Molecular diagnosis of hereditary canalicular cholestasis and familial hyperbilirubinemias

Článek Catheter ablation in atrial fibrillation

Článek Hyperglycemia and its control in the critically ill patient

Článek Acute liver failure: Present recommendations

Článek Specific program for perioperative care in paediatric liver transplantation

Článek Cadaver organ donor in transplantology