Experience of 352 Carotid Endarterectomy Cases Operated on without Any Shunt and a Technical Modification: Thirty-Day Results

Abstract

A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The necessity for an indwelling arterial shunt during carotid endarterectomy (CEA) is one of the most widely debated and long-standing controversies in carotid surgery. We developed a modified technique for carotid endarterectomy without using a shunt and have achieved successful results with this procedure. The aim of this study is to present these 352 isolated CEA cases and evaluate the results. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : In our clinic, 352 isolated CEA were performed on 320 consecutive patients without using a shunt between 2005 and 2012. In 32 of the cases, bilateral CEA were performed. Among the patients, 36.8 % (n=118) were neurologically asymptomatic, and 63.2 % (n=202) were symptomatic. Complete occlusion was present in the contralateral carotid arteries of 23 patients. All patients were operated on under general anesthesia, and no intraluminal shunts were used. This operative technique is a modification of an eversion carotid endarterectomy in which a longitudinal arteriotomy is begun on the common carotid artery (CCA) and purposely skewed towards the origin of the external carotid artery. The mean crossclamp time in our study was 12±4.62 minutes. R Re es su ul lt ts s: : There was one case of postoperative mortality (0.28%) that was caused by myocardial infarction. We observed 1 (0.28%) case of permanent neurologic deficit, 27 (7.6%) cases of peripheral nerve damage, 4 (1.1%) cases of early postoperative transient neurologic attack, 3 (0.85%) cases of hoarseness and 3 (0.85%) cases of neurocognitive impairment. C Co on nc cl lu us si io on n: : The results indicate that this mini-modified eversion CEA surgery performed without the use of a shunt can be successful for patients with carotid stenosis. K Ke ey y W Wo or rd ds s: : Endarterectomy, carotid; ischemic attack, transient; stroke Ö ÖZ ZE ET T A Am ma aç ç: : Karotis arter endarterektomi (CEA) cerrahisinde şant kullanım gerekliliği, yama kullanımı, eversiyon ve konvansiyonel endarterektomi teknikleri halen tartışılan konulardır. Kliniğimizde CEA operasyonları şant kullanılmadan yapılmaktadır. Yine bu operasyonlarda kliniğimizde geliştirilmiş olan farklı bir arteriyotomi tekniği kullanılmaktadır. Bu çalışmada şant kullanılmadan gerçekleştirilen 352 izole CEA olgusu değerlendirilmiş ve kliniğimizce geliştirilmiş olan tekniğinin tarifi ve erken dönem sonuçları tartışılmıştır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Kliniğimizde 2005-2012 yılları arasında 320 hastaya 32'si bilateral olmak üzere, toplam 352 izole CEA operasyonu uygulandı. Hastaların %36,8 (n=118)'i nörolojik olarak asemptomatik, %63,2 (n=202)'si ise semptomatik hastalardan oluşmaktaydı. Tüm hastalar genel anestezi altında ve şant kullanılmadan opere edildi. Endarterektomi, ana karotis arterden eksternal karotis artere longitudinal bir arteriyotomi insizyonu ile gerçekleştirildi. Ortalama kros klemp zamanı 12±4,62 dakika olarak ölçüldü. B Bu ul lg gu ul la ar r: : Genel anestezi altında...

Previous chronic cerebral infarction is predictive for new cerebral ischemia after carotid endarterectomy

“…It has been reported that eversion CEA has a lower restenosis rate than conventional CEA closure techniques and thus superior long-term durability. Today, eversion CEA is one of the most preferred technique with a postoperative stroke rate between 0.6 and 2.5 % [ 20 – 22 ]. In this study all of the cases were operated with eversion CEA technique.…”

“…In our clinique postoperative symptomatic stroke rate is under 2 % after CEA [ 22 ]. In this study, we found 8 new ischemic images on DWI which 1 of them symptomatic (1.9 %), 7 of them asymptomatic –silence- ischemia (13.7 %) after CEA.…”