Carotid endarterectomy with patch closure versus carotid eversion endarterectomy and reimplantation: A prospective randomized study

Ballotta, Enzo; Giau, Giuseppe Da; Saladini, Marina; Abbruzzese, Elvira; Renon, Laura; Toniato, Antonio

doi:10.1016/s0039-6060(99)70237-0

Cited by 83 publications

(53 citation statements)

References 26 publications

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“…Shunting criteria were based exclusively on EEG changes suggestive of cerebral ischemia. The technical details of the CEA procedure have been described elsewhere (Ballotta et al, 1999b).…”

Section: Surgical Proceduresmentioning

confidence: 99%

Cerebral Hemodynamics after Contralateral Carotid Endarterectomy in Patients with Symptomatic and Asymptomatic Carotid Occlusion: A 10-Year Follow-Up

Baracchini

Meneghetti

Manara

et al. 2006

J Cereb Blood Flow Metab

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We sought to investigate whether carotid endarterectomy (CEA) can achieve long-term cerebral hemodynamic improvement and reduce recurrence of cerebral ischemic events in symptomatic and asymptomatic patients with severe ( > 70%) carotid artery stenosis contralateral to carotid occlusion (CO). Thirty-nine patients with severe carotid lesion contralateral to CO were studied before (1 day) and after CEA (at 7 days, 1, 3 and 6 months, and then yearly thereafter). Collateral flow and cerebral vasomotor reactivity (VMR) were assessed by transcranial Doppler sonography (TCD). A total of 32 unoperated patients with severe carotid lesion contralateral to CO, who were comparable with respect to age and sex, served as a control group. The average period of TCD follow-up was 10 years and was obtained in all patients; during this period, major clinical events (stroke, acute myocardial infarction and death) were also recorded. The proportion of patients with collateral flow via the anterior communicating artery increased significantly from 61.5% before to 89.7% after CEA (P = 0.01). Cerebral VMR ipsilateral to CO improved in 85.7% of patients (30 of 35) within 30 days of CEA, and in all patients within 90 days. No significant spontaneous VMR recovery was recorded in the control group. After the initial recovery, no significant change in VMR was observed in the surgical group or the control group during the follow-up. In conclusion, in patients with severe carotid stenosis, CEA contralateral to symptomatic and asymptomatic CO determines a durable cerebral hemodynamic improvement not only on the side of the CEA but also on the contralateral side, with no difference between symptomatic and asymptomatic patients.

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“…Shunting criteria were based exclusively on EEG changes suggestive of cerebral ischemia. The technical details of the CEA procedure have been described elsewhere (Ballotta et al, 1999b).…”

Section: Surgical Proceduresmentioning

confidence: 99%

Cerebral Hemodynamics after Contralateral Carotid Endarterectomy in Patients with Symptomatic and Asymptomatic Carotid Occlusion: A 10-Year Follow-Up

Baracchini

Meneghetti

Manara

et al. 2006

J Cereb Blood Flow Metab

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“…[1,3,16,24,25] Eversion CEA is associated with a higher incidence of postoperative hypertension, higher levels of vasodilator use, and lower levels of vasopressor use after surgery compared to standard longitudinal endarterectomy with or without patch angioplasty. [1,3] This finding is most likely to be attributed to the baroreceptor apparatus and the almost certain need for carotid sinus nerve transection using the eversion technique.…”

Section: Discussionmentioning

confidence: 99%

Altered blood pressure responses of carotid endarterectomy in patients with contralateral carotid artery lesion

Akyüz¹

2016

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada kontralateral karotis arter lezyonu olan hastalarda karotis endarterektomiyi takiben ilk üç gün içinde değişmiş kan basıncı yanıtları değerlendirildi.Ça lış ma pla nı: Mart 2009 -Kasım 2012 tarihleri arasında karotis endarterektomi yapılan toplam 111 hasta (52 erkek, 59 kadın; ort. yaş 67.7±8.6 yıl; dağılım 46-83 yıl) retrospektif olarak incelendi. Hastalar iki gruba ayrıldı: kontralateral karotis arter patent olan (grup 1, n=65) ve kontralateral karotis arter darlığı (%50-99) veya tıkanıklığı olan (grup 2, n=44). Ameliyat sonrası izlem sırasında başlangıca kıyasla kan basıncındaki değişiklikler incelendi ve gruplar arasında karşılaştırıldı. Bul gu lar:Ameliyat sonrası dönemde, grup 1'e kıyasla, grup 2 hastalarında sistolik, diyastolik ve ortalama arteriyel basınç değerleri istatistiksel olarak daha yüksekti (p<0.05). Ameliyat sonrası dönemde intravenöz antihipertansif ilaç ihtiyacı, grup 1'e kıyasla, grup 2'de anlamlı düzeyde daha fazla idi (p<0.05). Karotis endarterektomi sonrası yatış sırasında grup 2'de 25 hastada (%56.8) ve grup 1'de 14 hastada (%21.5) mevcut antihipertansif tedavinin dozu artırıldı veya antihipertansif tedaviye ilaç eklendi (p<0.05). Grup 2'de bir hastada geçici iskemi atak şeklinde nörolojik komplikasyon görüldü. İki grupta da hiçbir hastada ameliyat sonrası anlamlı nörolojik, cerrahi veya kardiyak komplikasyon gelişmedi.So nuç: Bu çalışma, karotis endarterektomi planlanan hastaların kontralateral internal karotis arterde darlık (%50-99) veya tıkanma varlığında ameliyat sonrası hipertansiyon açısından yüksek riskli olduğunu gösterdi.Anah tar söz cük ler: Karotis endarterektomi; kontralateral darlık; tıkanma; ameliyat sonrası hipertansiyon. ABSTRACT Background:In this study, we evaluated altered blood pressure responses within the first three days following carotid endarterectomy in patients with contralateral carotid artery lesion.

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“…Numerous studies have compared standard CEA plus patching with eversion once [7][8][9][10][11][12][13][14][15][16][17][18]. Regarding the total operating and ischemic time, as well as perioperative complications, first studies has favored to eversion CEA [7,8].…”

Section: Reviewmentioning

confidence: 99%

“…One of these studies that compared conventional and eversion CEA has been conducted and designed in a truly interesting manner. Namely, on the one carotid artery at the same patient, Balotta and associates performed eversion, while on another side conventional CEA [9]. Regarding early and long term results, eversion CEA has been better [10].…”

Section: Reviewmentioning

confidence: 99%

“…8). Eversion CEA, which employs a transverse arteriotomy and reimplantation of the internal carotid artery or end-to-end anastomosis between proximal and distal segments of the common carotid artery, is reported to be associated with low restenosis [7][8][9][10][11][12][13][14][15][16][17][18][19]. The false anastomotic aneurysms occurrence during the follow-up period is almost impossible [17,19].…”

Section: Reviewmentioning

confidence: 99%

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Carotid Endarterectomy: Eversion Technique

Davidović¹,

Tomić²,

Marković³

et al. 2015

UCMS

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Abstract:The aim of this article is to explain technique of eversion CEA (carotid endarterectomy), as well as to determine that eversion CEA is more effective than conventional CEA. Eversion CEA can be performed in two methods. When atherosclerotic process mostly involves common carotid artery, the procedure should start with common carotid transection, followed by eversion CEA in cranial and than in caudal direction. The final step is reanastomosis. If atherosclerotic process is mostly localized at the internal carotid artery origin, procedure begins with origin transection. The following steps are eversion endarterectomy of the internal carotid artery, then endarterectomy of carotid bifurcation if it is necessary, and reimplantation of the internal carotid artery. There is no obvious consensus that eversion CEA is superior in regard to conventional one. However, eversion CEA is anatomic procedure that reduces ischemic and total operative time, as well as restenosis and false anastomotic aneurysms occurrence during the follow-up period. It excludes the usage of patches and enables simultaneous correction of the joined kinking or coiling. Eversion CEA, performed by an experienced surgeon is safe, effective, and durable procedure.

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Carotid endarterectomy with patch closure versus carotid eversion endarterectomy and reimplantation: A prospective randomized study

Cited by 83 publications

References 26 publications

Cerebral Hemodynamics after Contralateral Carotid Endarterectomy in Patients with Symptomatic and Asymptomatic Carotid Occlusion: A 10-Year Follow-Up

Cerebral Hemodynamics after Contralateral Carotid Endarterectomy in Patients with Symptomatic and Asymptomatic Carotid Occlusion: A 10-Year Follow-Up

Altered blood pressure responses of carotid endarterectomy in patients with contralateral carotid artery lesion

Carotid Endarterectomy: Eversion Technique

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