Conventional carotid endarterectomy with shunt versus eversion carotid endarterectomy without shunt does the technique influence the outcome in symptomatic critical carotid stenosis

Introduction: Carotid endarterectomy (CEA) is a surgical procedure done to prevent future embolic stroke in patients with internal carotid artery (ICA) stenosis. Conventional CEA (c-CEA) and eversion CEA (e-CEA) are two surgical techniques used for the above. As carotid shunt is rarely used in e-CEA, a certain amount of cerebral ischemia occurs in patients who were already having carotid stenosis. In this study, we have evaluated the outcome of two surgical techniques in severe carotid stenosis and impact of carotid shunting on the postoperative outcome. Materials and Methods: In this single-center prospective nonrandomized trial, a total of 62 patients who underwent CEA (c-CEA, n = 31; e-CEA, n = 31) for symptomatic ipsilateral ICA stenosis ≥50% between January 2018 and December 2019 were included. Results: A total of 62 patients who underwent CEA (c-CEA, n = 31; e-CEA, n = 31) for symptomatic ipsilateral ICA stenosis ≥50% were included in the study. There was no major stroke or stroke related death in both the study groups. One patient in e-CEA had carotid occlusion and minor stroke. There was no statistically significant difference in minor stroke (e-CEA [3.2%], c-CEA [3.2%], P = 1), transient ischemic attack (e-CEA [3.2%], c-CEA n = 0, P = 0.3), postoperative MI (e-CEA (3.2%), c-CEA (3.2%), P = 1), hematoma (e-CEA [3.2%], c-CEA n = 0, P = 0.3), and re-exploration (e-CEA [3.2%], c-CEA n = 0, P = 0.3). The incidence of cranial nerve (CN) dysfunction was significantly higher in eversion group as compared to c-CEA (e-CEA n = 6 [19.4%], c-CEA n = 1, [3.2%] P = 0.045). Conclusion: Our study showed that the early outcomes of both c-CEA and e-CEA techniques are comparable. The routine insertion of carotid shunt even though decreases the cerebral ischemic time, it does not offer any additional advantage of decreasing perioperative stroke. The choice of the CEA technique depends on the experience and familiarity of the individual surgeon as both the techniques have their own advantages and disadvantages.

Key-words:

Carotid endarterectomy - carotid shunting - conventional carotid endarterectomy - eversion carotid endarterectomy

Financial support and sponsorship

Nil.

Publication History

Received: 29 October 2020

Accepted: 15 February 2021

Article published online:
16 August 2022

• References

• 1 Ricotta JJ, AbuRahma A, Ascher E, Eskandari M, Faries P, Lal BK. updated society for vascular surgery guidelines for management of extracranial carotid disease. J Vasc Surg 2011;54:e1-31.
• 2 Davidovic LB, Tomic IZ. Eversion carotid endarterectomy: A short review. J Korean Neurosurg Soc 2020;63:373-9.
• 3 Cao P, Giordano G, De Rango P, Zannetti S, Chiesa R, Coppi G, et al. A randomized study on eversion versus standard carotid endarterectomy: Study design and preliminary Results: The Everest Trial. J Vasc Surg 1998;27:595-605.
• 4 Lareyre F, Raffort J, Weill C, Marsé C, Suissa L, Chikande J, et al. Patterns of acute ischemic strokes after carotid endarterectomy and therapeutic implications. Vasc Endovascular Surg 2017;51:485-90.
• 5 Hans SS, Catanescu I. Selective shunting for carotid endarterectomy in patients with recent stroke. J Vasc Surg 2015;61:915-9.
• 6 Kakisis JD, Antonopoulos CN, Mantas G, Moulakakis KG, Sfyroeras G, Geroulakos G. Cranial nerve injury after carotid endarterectomy: Incidence, risk factors, and time trends. Eur J Vasc Endovasc Surg 2017;53:320-35.