[Comparison of the therapeutic effects of modified endarterectomy and traditional endarterectomy for carotid artery stenosis]

Abstract

Objective: To compare the clinical efficacy of the modified eversion carotid endarterectomy (M-ECEA) by comparing it with the conventional eversion carotid endarterectomy (C-ECEA). Methods: This interim analysis of a prospective randomized controlled study enrolled eligible patients with carotid artery stenosis admitted to the Department of Vascular Surgery at the Second Affiliated Hospital of Nanchang University between September 2022 and September 2024. Patients were allocated in a 1∶1 ratio to either the M-ECEA group or the C-ECEA group using simple randomization. The key modification of the M-ECEA technique was as follows: the incision started at the side of the external carotid artery opposite the origin of the superior thyroid artery, descended along the external carotid artery, followed a curved path to avoid the carotid sinus and carotid body region, and ended on the internal carotid artery side of the common carotid artery; identical incisions were made on the anterior and posterior walls with complete transection, and the remaining steps were the same as for C-ECEA. All surgeries were performed by the same surgical team. Postoperative hemodynamic changes, the usage of antihypertensive medications, and short-term adverse events were collected and compared between the two groups. Data comparisons were conducted using independent sample t-tests, χ² tests, or Fisher's exact probability method. Results: A total of 100 patients were enrolled. There were 50 cases in the C-ECEA group, 41 males,9 females,aged (68.4±6.3) years(range:53 to 77 years) and 50 cases in the M-ECEA group,38 males, 12 females, aged (68.3±7.2) years(range:range 44 to 81). All procedures were successfully completed. Regarding hemodynamics, the incidence of postoperative hypertension was lower in the M-ECEA group than in the C-ECEA group (60.0%(30/50) vs. 90.0%(45/50), χ²=12.000, P<0.01). Notably, the systolic blood pressure at 1 hour postoperatively was significantly lower in the M-ECEA group ((132.6±20.0) mmHg vs. (154.2±21.3) mmHg (1 mmHg=0.133 kPa),t=-5.212, P<0.01). Intraoperative metrics showed that the carotid artery clamp time was significantly shorter in the M-ECEA group ((25.3±2.1) min vs. (26.2±1.9)min, t=-3.020, P=0.003). Regarding medication use, the postoperative rate of antihypertensive drug administration was significantly lower in the M-ECEA group (44.0%, 22/50) than in the C-ECEA group (86.0%, 43/50)(χ²=19.385, P<0.01). In terms of safety, no reoperations or deaths occurred in either group. Postoperative cerebral infarction occurred in one patient in each group. Myocardial infarction and cerebral hyperperfusion syndrome each occurred in one patient, both within the C-ECEA group. The overall incidence of adverse events showed no significant difference between the groups (P>0.05). Conclusion: The M-ECEA technique, by avoiding the carotid sinus and carotid body region, effectively reduces the incidence of postoperative hypertension, promotes postoperative hemodynamic stability, and decreases the need for antihypertensive medications, without significantly reducing the risk of postoperative adverse events.