Carotid eversion endarterectomy revisited.

Carotid eversion endarterectomy appears to be a safe and anatomically acceptable alternative to the standard carotid bifurcation endarterectomy, as evidenced by the absence of permanent neurologic morbidity and mortality in 98 operations. Preliminary clinical, angiographic, and noninvasive laboratory parameters suggest that there is a significant reduction of both residual technical defects and early recurrent stenosis. Specifically, no perioperative thrombosis or early restenosis was encountered in the 98 endarterectomies. Furthermore, only two technical defects have been noted, and one of these occurred in one patient who required a longitudinal arteriotomy and attendant suture line when the common carotid artery was transected too proximally and the eversion maneuver could not be accomplished. Serial long-term clinical and noninvasive laboratory follow-up evaluation, in addition to indicated postoperative angiography, will continue in an effort to assess the durability of a technical approach to carotid endarterectomy that may minimize residual defects and early restenosis.