Endarterectomy of the external carotid artery

Czech version

Authors: P. Dráč ¹; D. Šaňák ²; P. Utíkal ¹; M. Černá ³; M. Köcher ³; P. Bachleda ¹
Authors‘ workplace: 2. chirurgická klinika, LF UP a FN Olomouc ¹; Komplexní cerebrovaskulární, centrum, Neurologická klinika, LF UP a FN Olomouc ²; Radiologická klinika, LF UP a FN Olomouc ³
Published in: Cesk Slov Neurol N 2020; 83(2): 194-197
Category: Short Communication
doi: https://doi.org/10.14735/amcsnn2020194

Overview

Aim: Endarterectomy of the external carotid artery (eCEA) is rarely used in patients with neurological or ocular symptoms due to the chronic ipsilateral occlusion of the internal carotid artery (ICA) with severe stenosis of the external carotid artery. However, sufficient evidence of its benefits has not been established. The aim was to analyze results of our patients who underwent eCEA.

Patients and methods: All patients, who underwent eCEA between 2007–2019, were enrolled in this retrospective analysis. A detailed ultrasound examination of intracranial vessels with a quantification of hypoperfusion in the middle cerebral artery (MCA) on the side of the ICA occlusion was performed in all patients before surgery. After eCEA, clinical and US follow-up was performed in all patients.

Results: In total, four patients (3 males, mean age 67 ± 7 years) with previous neurologic or ocular symptoms due to the ICA occlusion and with hypoperfusion in the MCA before eCEA were enrolled in the study. In three patients, eCEA was done under regional cervical anesthesia and in one patient under general anesthesia. No complications related to the surgery and during the follow-up were recorded in all patients. An improvement of flow velocity in the MCA occurred in one patient and transient normalization of flow velocity was detected in another patient. None of the patients suffered from recurrent neurologic or ocular symptoms during the follow-up (median of 32 months).

Conclusion: Our results may support the benefit of eCEA in the carefully selected symptomatic patients. Due to absence of clear evidence of the benefits of eCEA, the indication for surgery in routine clinical practice should be carefully considered by an experienced vascular neurologist and vascular surgeon.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Keywords:

external carotid artery – chronic occlusion – endarterectomy – carotid stump syndrome

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