Shah D M, Darling R C, Chang B B, Paty P S, Kreienberg P B, Lloyd W E, Leather R P
Division of Vascular Surgery, Center for Vascular Disease, Albany Medical College, New York 12208, USA.
Ann Surg. 1998 Oct;228(4):471-8. doi: 10.1097/00000658-199810000-00004.
The outcome of standard longitudinal carotid endarterectomy (CEA) can be measured by preservation of neurologic function with a low incidence of restenosis. Closure of the internal carotid arteriotomy with or without a patch may predispose to restenosis. Alternatively, transection of the internal carotid artery at the bulb with eversion endarterectomy allows expeditious removal of the plaque and direct visualization of the endpoint. Because the proximal internal carotid artery is anastomosed to the common carotid artery, this obviates the need for patch closure. The authors report their results with this technique in more than 2200 procedures.
From May 1993 to March 1998, 1855 patients underwent 2249 CEAs using the eversion technique. During the same period, 410 patients had 474 CEAs by standard technique. Three hundred fifteen procedures in the eversion group and 65 procedures in the standard group were combined CEA and coronary artery bypass grafts. Most solo CEAs (97%) were performed in awake patients using regional anesthesia. Shunts were used on demand in 6% of CEAs.
The operative mortality rate was 1.02% (16/1575) in the solo eversion group and 2.2% (9/410) in the standard group. There were 18 permanent neurologic deficits (0.8%) in the eversion group and 11 (2.3%) in the standard group. Transient neurologic deficits occurred in 20 patients (0.9%) in the eversion group and 13 patients (2.7%) in the standard group. Of the 1855 patients, 1786 (96%) presented for duplex ultrasound follow-up. There were seven (0.3%) stenoses greater than 60% in the eversion group versus five (1.1%) in the standard group.
Eversion CEA can be performed safely with a low rate of stroke and death and a minimal restenosis rate in short- and long-term follow-up.
标准纵向颈动脉内膜切除术（CEA）的结果可以通过神经功能的保留以及再狭窄低发生率来衡量。使用或不使用补片闭合颈内动脉切开处可能会导致再狭窄。另外，在球部横断颈内动脉并进行外翻内膜切除术能够迅速清除斑块并直接观察到手术终点。由于近端颈内动脉与颈总动脉进行吻合，因此无需补片闭合。作者报告了他们在超过2200例手术中使用该技术的结果。
从1993年5月至1998年3月，1855例患者采用外翻技术进行了2249例CEA手术。同期，410例患者采用标准技术进行了474例CEA手术。外翻组315例手术和标准组65例手术为CEA联合冠状动脉搭桥术。大多数单独的CEA手术（97%）在清醒患者中使用区域麻醉进行。6%的CEA手术按需使用分流管。
单独外翻组的手术死亡率为1.02%（16/1575），标准组为2.2%（9/410）。外翻组有18例永久性神经功能缺损（0.8%），标准组有11例（2.3%）。外翻组20例患者（0.9%）出现短暂性神经功能缺损，标准组13例患者（2.7%）出现。1855例患者中，1786例（96%）接受了双功超声随访。外翻组有7例（0.3%）狭窄大于60%，标准组有5例（1.1%）。
外翻CEA手术可安全进行，在短期和长期随访中卒中率和死亡率低，再狭窄率极低。
