Comparative analysis of carotid endarterectomy late outcomes related to intervention modality.

The paper presents a comparative analysis of late outcomes after 105 carotid endarterectomies (CEA) performed in 89 patients from 1997 to 2003, including 95 patients (90.5%) operated for atherosclerotic stenosis of internal carotid artery (ICA) and 7 patients (6.6%)--for combined ICA stenosis and tortuosity. The severity distribution of cerebrovascular insufficiency (CVI) was the following: grade I--in 22.8%, grade II--in 12.4%, grade III--in 25.7% and grade IV--in 38.1% of patients. CEA methods included eversion endarterectomy in 50.4% cases and open (classic) surgical CEA with PTFE patch angioplasty in 49.6% cases. Mean follow-up period was 31.8 months for the eversion CEA group and 37 months--for the open CEA group (from 3 to 72 months). In 76.4% patients the duration of follow-up period exceeded 1 year. During the follow-up period all patients underwent clinical examination and color duplex scanning of reconstructed CA segment with assessment of diameter, vascular wall thickness and blood flow. TIA was registered in 1 patient from eversion CEA group and in 1 patient from open CEA group. Thus, in the long-term postoperative period 98% of patients were free from neurological complications. Hemodynamically significant restenoses developed in 8 cases (7.6%), including 4 patients from the eversion CEA group and 4 patients from the open CEA group. Myointimal hyperplasia (> 3 mm) accompanied by hemodynamical alterations occurred in 1 patient from the eversion CEA group and in 2 from the open CEA group. In the rest of cases restenoses were related to atherosclerotic plaque formation. In conclusion, the long-term outcomes indicate that CEA is effective in the prevention of cerebrovascular events regardless of carotid angioplasty strategy. The rate of late postoperative restenoses was similar for eversion and open CEAs. Both modalities can be promising for the surgical correction of CA stenoses.