An Institutional Experience of Modified Eversion Endarterectomy in the Management of Carotid Artery Stenosis

Background: Carotid endarterectomy (CEA) using eversion technique has been used by vascular surgeons across the world. A simpler technique, modified eversion endarterectomy (MEE) is emerging as a promising option. Advantages are shorter clamping time, less neurological complications, and avoidance of prosthetic patch plasty. Selective shunting can be done whenever required. In the climate of carotid artery stenting versus CEA debate, one would consider this method to reduce the morbidity of CEA. Materials and Methods: This is a retrospective analysis of patients undergoing CEA at a single institution by four vascular surgeons over a period of 2½ years (January 2012–June 2014). Data were collected from computerized medical records and various parameters analyzed. Forty patients underwent MEE during the given period. The majority were symptomatic 34 (85%). Results: One patient (2.5%) required conversion to conventional endarterectomy with patch plasty because of the long length of the plaque. One patient (2.5%) had lateralizing transient ischemic attack (TIA) in the postoperative period. Two patients had hematoma of which one was returned to operating theater for evacuation. Seven patients underwent MEE along with coronary artery bypass grafting with uneventful recovery. Selective shunting was done for four patients (10%) who had a contralateral occlusive disease or poor back bleed from an internal carotid artery (ICA) on table. Average ICA cross-clamping time was 13 min. None of the patients had cerebrovascular accident/TIA in the follow-up period. Conclusions: MEE is a simpler and easier technique to perform with comparable results when compared with other conventional techniques. MEE, in our assumption, will be the technique of choice in the future for open CEA; however, larger studies with longer follow-up are required before final validation of this technique