Arteriotomy for Carotid Endarterectomy, from Common to Interna or Externa?

Abstract

Objectives: In this study, we described and compared a modified carotid endarterectomy surgical technique. Our comparison was between arteriotomy incision from common to interna and from common to externa.

Methods: This study included 73 isolated carotid anrterctomy operations from two different centers. We performed external incision in 61 cases (Group A) and internal incision in 12 cases (Group B). We also elaborated perioperative data and surgical results between Groups. All cases were performed under general anaesthesia.

Results: 2 patients in Group A and 2 patients in Group B died at the early postoperative period due to severe neurological deteriorations in 3 and myocardial infarction in 1 case. All cases were solely operated for carotid artery stenosis. None of these patients were presenting contrlaterally serious carotid artery lesions.  4 patients from Group A and 3 patients from Group B were receiving haemodialysis, perioperatively. Trancient minor neurological complications such as lingual deviation and/or facial asymmetry which were associated with N.Hypoglossus injuries, was observed in 8 cases and 2 cases in Group A and Group B, respectively. Patchplasty was necessary in 5 from Group A. No patchplasty was applied in Group B. We tried to avoid carotid shunt from common to interna in all standart procedures. However, carotid shunt was mandatory in 4 patients and in 1 patient from Group A and B.

Conclusion: Our modified carotid incision from common to externa is almost always suitable for internal plaque removal. Thus, an incision to interna can be avoided which prevents internal artery narrowing, endothelial disruption and/or occlusion prone deterioration and internal artery intraoperative dissection risks. Therefore, we believe that an incision from common to external carotid artery is the first choice surgical approach for carotid endarterectomy.