#1 - Eversion Carotid Endarterectomy: a Versatile and Durable Procedure. an Analysis of 7781 Procedures

Purpose: Eversion carotid endarterectomy (CEA) is an effective form of management for atherosclerotic carotid bifurcation disease. Despite the early origins of this technique, it is still used infrequently as an alternative to the standard longitudinal patch closure. In this study we outline our results with the use of eversion endarterectomy for carotid disease over the past 14 years in over 7700 cases. all patients undergoing CEA were reviewed retrospectively in our vascular registry. Patients undergoing combined CEA with coronary procedures were included. The preferred anesthetic technique for CEA was regional with shunt on demand except in combined procedures where general anesthesia was used without shunt. Mortality and morbidity were reviewed and demographics analyzed. Restenosis was defined at >70%. Results: 6638 patients underwent 7781 CEAs in the study period using the eversion technique. There were 667 procedures performed with combined coronary procedures. The majority (91%) were done in awake patients with a regional anesthesia. Shunts were used on demand in 1.2% of patients undergoing awake CEA. The operative mortality was 51/7114 (0.7%) in the solely eversion group and 21/667 (3.2%) in those patients undergoing combined procedures. There were 76 permanent and 65 temporary neurologic deficits in the eversion group. In long term follow-up there were 102 recurrent stenoses in the eversion group. There was no difference in stroke or mortality based on gender or on the presence/absence of diabetes. Conclusion: Eversion endarterectomy can be performed safely with low stroke mortality rates. It can be used in high risk patients with acceptable results and has minimal restenosis in long term follow-up. Objective: Recent studies reveal consistently higher periprocedural risk of stroke during carotid angioplasty and stenting (CAS) in octogenarians yet the mechanisms for this increased risk are poorly understood. We analyzed aortic arch calcium content to determine whether it is influenced by age, arch type or patient comorbid conditions. Methods: Aortic arch calcium content and arch classification were examined in consecutive patients undergoing CT scans with aortic dissection protocol. Aortic arch calcium content was determined using a coronary calcium score (Vitrea 2.0); arch classification was determined by multiplanar reconstruction. ANOVA and multivariable logistic regression were used to determine statistical significance. There was significantly more arch calcium in patients over 75 years compared to younger patients (2,458 ± 447 vs. 145 ± 49, p<0.001). Patients with type II aortic arches had higher calcium content compared to type I aortic arches (2,028 ± 546 …