Repermeation Without Pharmacological Thrombolysis of the Extracranial Symptomatic Occlusions of the Internal Carotid Artery: Results of the Early Carotid Endarterectomy

Objectives: Two types of carotid endarterectomies (CE) are currently practiced, longitudinal CE with patch (CEP) or by eversion. We propose a new technique, the ‘‘carotidoplasty’’ (CP), which is freed from an excess length of the carotid bifurcation (sometimes problematic for the CEP) and of the stop of plaque (sometimes problematic for eversion). The objective of our study was to evaluate the results of CP in the short and long term. Materials and Methods: Technique: CP consists in a skeletonization of the carotid bifurcation to mobilize it, divide the internal carotid obliquely, and carry out a longitudinal arteriotomy of the carotid bulb then an endarterectomy of the bulb and external carotid. The internal carotid is endarterectomized a minima under visual control then obliquely reimplanted in the bulb by a circular running suture, which makes it possible to secure an atherosclerotic plaque if necessary, to correct a possible excess of length, and to obtain a quasi-anatomical restitution of the carotid bifurcation. From a prospective database, we studied the CE (n1⁄4748) carried out in our unit by CEP (n1⁄4624, 83.4%) and by CP (n1⁄4 73.9.8%) between January 1st, 2007 and December 31st, 2011. We analyzed the demographic criteria (sex, age, cardiovascular risk factors, and comorbidities), the degree of stenosis, the symptomatic character and the type of symptoms of the carotid stenoses, the status of the contralateral carotid, the type of anesthesia, the cross clamp time, the need for a shunt, the early reinterventions, and the longterm follow-up. The principal criterion of judgment was the CRMM (rate of stroke or death at 30 days). The secondary criteria of judgment were the rates of residual stenosis, of postoperative thrombosis, of restenosis, and of long term survival. Results: The average time of follow-up was 30.5 months (1 to 72 months). The significantly different elements between CP and CEP were: the age (75.8 years ± 8.9 vs 72.9 years ± 9.6, p1⁄4 0.015), the cross clamp time (36 min ± 7.6 vs 40.3 min ± 11.0, p1⁄40.005), and the rate of restenosis (0 vs 5.3%, p1⁄40.039), respectively. The CRMM were 0% vs 3.4%, respectively, without significance (p1⁄40.153). The other analyzed parameters were not different. Conclusion: The carotidoplasty, a new surgical technique, showed satisfactory results in the short and long term, in this monocentric experience. Its interest must be confirmed in more patients with a multicentric evaluation.