Arteriotomy for Carotid Endarterectomy, from Common to Interna or Externa?

Objective: Carotid endarterectomy is an evolving and changing procedure over its almost 70 years history. Surgery is commonly described as a total removal of plaques from the carotid tree maintained via an arteriotomy from common carotid artery to internal carotid artery. We aim to express our opinion that an incision to external carotid artery may always provide adequate reach to a plaque of internal carotid artery side. So, there is no need of internal carotid artery involvement during arteriotomy. Materials and Methods: 73 patients were included to study. All patients underwent single-sided Carotid Endarterectomy. Group A (n=61) and Group B (n=12). Group A included our primary cases Carotid Endarterectomy with artery incision Common Carotid Artery to External Carotid Artery in 61 patients. Group B patients of 12 cases received an artery incision from Common Carotid Artery to Internal Carotid Artery. Results: 2 patients in Group A (3.2%) and 2 patients (16.6%) in Group B died at the early postoperative period due to severe neurological deteriorations in 3 (4.1%) and myocardial infarction in 1 (1.3%) case, p

PDF

___

[1] Landis GS, Faries PL. A critical look at “high-risk” in choosing the proper intervention for patients with carotid bifurcation disease. Semin Vasc Surg. 2007; 20 (4):199-204.
[2] Qin F, Sun Y, Hu W, et al. The relationship between preoperative serum cortisol level and the stability of plaque in carotid artery stenosis patients undergoing carotid endarterectomy. J Thorac Dis. 2016; 8 (7):1611-7.
[3] Lal BK, Beach KW, Roubin GS et al. Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial. Lancet Neurol. 2012; 11(9):755-63.
[4] Hye RJ, Mackey A, Hill MD et al. Incidence, outcomes, and effect on quality of life of cranial nerve injury in the Carotid Revascularization Endarterectomy versus Stenting Trial. J Vasc Surg. 2015; 61 (5):1208-14.
[5] Tedesco MM, Lee JT, Dalman RL et al. Postprocedural microembolic events following carotid surgery and carotid angioplasty and stenting. J Vasc Surg 2007;46:244-50.
[6] Schnaudigel S, Groschel K, Pilgram SM et al. New brain lesions after carotid stenting versus carotid endarterectomy: a systematic review of the literature. Stroke 2008; 39:1911-9.
[7] Pujol Lereis VA, Ameriso S, Povedano GP et al. Morbidity and mortality of carotid endarterectomy. Medicina (B Aires). 2011;71(5):449-53.
[8] Savardekar AR, Narayan V, Patra DP, et al. Timing of Carotid Endarterectomy for Symptomatic Carotid Stenosis: A Snapshot of Current Trends and Systematic Review of Literature on Changing Paradigm towards Early Surgery. Neurosurgery. 2019; 85(2):214-225.