Carotid eversion endarterectomy: prospects in a developing country.

angladesh has an estimated population of 130 million. Approximately 1.2 million of them are disabled. It is estimated that 70% of them are due to consequences of stroke.1 Stroke is the most common cause of death as a result of neurologic disorders and the third leading cause of death in the United States of America each year. Ischemic stroke from atherosclerotic lesions of the carotid bifurcation is the most common cause of stroke in adults.2 In recent years carotid endarterectomy has proved to be the most effective form of management for atherosclerotic carotid bifurcation disease. The primary objective of surgery for extracranial lesions involving the cerebrovascular system is the prevention of stroke. The early results comparing carotid endarterectomy by standard method with or without patch to that of eversion endarterectomy suggests that eversion endarterectomy by itself may be a better and more beneficial way to perform carotid endarterectomy. There are various prospective randomized studies suggesting that eversion carotid endarterectomy allows to remove the entire atherosclerotic plaque and closure of the carotid artery at the widest part such as the carotid bulb. Therefore, early occlusion, restenosis, stroke and mortality rates have improved.2-5 The paper highlights the surgical procedure involved in carotid eversion endarterectomy, evaluates the perioperative results and examines its prospects in a developing country like Bangladesh. Fifteen patients of the Neurology Department of the Bangabandhu Sheikh Mujib Medical University (BSMMU), and 8 patients of the vascular surgery department of the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh are included in this study. Thirteen of them were subjected to carotid endarterectomy by eversion technique during February through to May, 2002. After proper clinical evaluation all 23 patients were examined by carotid duplex and 8 re-evaluated by magnetic resonance angiography. All patients revealed significant stenosis at carotid bifurcation, internal carotid artery (ICA) and external carotid artery (ECA) origins above the range of 60-70% and more. Indications of surgery was based on prospective randomized trials which provided definitive data concerning indication for carotid endarterectomy3,4 1. Patients with hemispheric or monocular transient ischemic attacks (TIAs) or prior mild stroke with a 70% or greater stenosis. 2. Patients B Brief Communication