Selective carotid endarterectomy brings about the advantages of conventional and eversion endarterectomy

Aims: Selective endarterectomy is described as extraction of atheromatous plaque through an arteriotomy made starting from common carotid artery (CCA) and extending to external carotid artery (ECA). The aim of this study was to report the initial experience selective endarterectomy technique at our department. Patients and methods: Prospectively collected data on all selective carotid endarterectomies were retrospectively analysed. The study period started in May 2011 and ended at the end of July 2012. A total of 21 had selective endarterectomy. The patients were operated under general anesthesia.The arteriotomy was done starting from the CCA and extended to the ECA. The atheromatous plaque was seen and starting from the CCA side, endarterectomy cleavage plane was seen. The plaque was encircled and cut in the CCA side. The plaque was then separated from the cleavage plane up to ECA. The plaque was either taken out up to end point in the ECA or cut circumferentially if it is thought to end very distally. After freeing the CCA and ECA sides of the plaque, the ICA endarterectomy was done by everting the ICA to the arteriotomy. The plaque was everted up to the end point. After flushing the endarterectomized artery with saline, the arteriotomy was closed primarily starting from the ECA side. Results: Mean age of the patients was 70.4 ± 6.2 years. The risk factors were coronary artery disease in 7 patients, hypertension in 10 patients, smoking in 6 patients, hypercholesterolemia in 10 patients, diabetes in 11 patients, peripheral arterial occlusive disease in 2 patient and family history of coronary artery disease in 4 patients. One patient had simultaneous coronary artery bypass surgery for severe left main coronary artery disease. No hospital deaths were seen. Two patients had cervical hematoma which regressed without revision. The mean carotid artery clamping time was 13.9 ± 3.6 minutes (range 8 – 25 minutes). Mean postoperative hospitalization time was 3.5 ± 1.1 days. Conclusion: Selective endarterectomy is a safe and simple procedure which has significantly low cerebral ischemic times.