Short non-patch arteriotomy in carotid endarterectomy

Abstract

Background: Several techniques of carotid endarterectomy have been described and currently used in clinical practice. We describe and report the midterm results of short non-patch arteriotomy technique.

Methods: We analyzed patients treated at our Department for carotid artery stenosis. Main outcomes were mortality, stroke, restenosis and local complications. The technique consists in a short longitudinal arteriotomy from common carotid artery to internal (ICA), followed by thromboendarterectomy in carotid bulb with a blunt spatula, cutting the more proximal edge of the plaque. A semi-eversion is then performed in the ICA to fully remove carotid plaque.

Results: In the period between years 2011-2016 we performed 476 carotid endarterectomies of which 436 with short non-patch arteriotomy. Mean clamping time was 15.5±5.7 minutes. In-hospital complications were: three cases of stroke (0.7%), all with complete recovery, four transient cerebral ischemia (0.9%), 14 cervical hematomas (3.2%), and four cranial nerve injuries (0.9%), which was in all cases completely regressed. At two years, we report six cases of carotid restenosis (1.4%), all treated with carotid stenting.

Conclusions: Short non-patch carotid endarterectomy technique resulted in a low mid-term rates of stroke, restenosis, and cranial nerve injuries compared to other surgical series in the literature.