Carotid endarterectomy with modified eversion technique: results of a Single Center.

BACKGROUND Carotid endarterectomy (CEA) has a wide range of approaches, based on personal expertise and preference. We evaluated our outcome with CEA with modified eversion technique (meCEA) under local anaesthesia and whether surgeon' experience could influence it. METHODS at our Institution, 837 patients underwent CEA across 8 years. Although surgical technique was standardized, two groups were considered further: meCEA performed by a single Senior Operator (Group A) and meCEA performed by four young Consultants (Group B). RESULTS A selective shunting policy was needed in 5.1%, together with general anaesthesia. Overall operative time was 63.9 ± 15.1 minutes (61.4 ± 12.5 and 66 ± 16.9 minutes in Group A and Group B respectively; p < .001) and cross-clamp time 19.3±2.9 minutes (19.0±3.2 vs. 19.5±2.8, p=.009). At 30 days, 0.7% TIA and 0.8% strokes were recorded. No differences (p=N.S.) between the two study groups in terms of post-operative neurological complications, with postoperative ipsilateral strokes always < 1%. At a median imaging follow-up of 22.5 months, the overall percentage of restenosis was 3.7%, with no difference between the two groups (p= .954). Twenty-two patients (2.6%) underwent reintervention for significant restenosis, none of these had ipsilateral stroke or TIA. Freedom from reintervention for restenosis at 24 months was 97.9% in Group A and 95.9% in Group B, with no between-groups difference (p= .14). At the median survival follow-up of 37 months the overall survival rate at 24 months was 97.9%in Group A, and 97.9% in Group B, with no between-groups difference (p = .070). CONCLUSIONS In our experience, CEA with modified technique, is safe and achieves comparable outcomes to those of other established techniques. The reported short cross-clamp time, also in less experienced hands, is an additional strength.