1. Perspective randomized study on eversion carotid endarterectomy : DeBakey-Van Maele technique vs Etheredge technique. Preliminary results
DOMENICO PALOMBO
Vascular and Endovascular Unit
IRCCS San Martino University Hospital - IST Genoa
University of Genoa

2. INTRODUCTION

3. INTRODUCTION Surgical techniques But which technique for the eversion?
reduced incidence of restenosis in the group receiving EA for eversion, without finding differences in the incidence of stroke during follow up .
But which technique for the eversion?
1) Cao P. et al. Eversion versus conventional carotid endarterectomy for preventing stroke (review). The Cochrane Library 2009 issue 4.

4. INTRODUCTION
Restenosis Follow-up

5. Endarterectomy according
INTRODUCTION
Endarterectomy according
De Bakey (EDB)

6. INTRODUCTION

7. Endarterectomy according Etheredge (EE)
INTRODUCTION
Endarterectomy according Etheredge (EE)

8. INTRODUCTION

9. Eversion endarterectomy:
INTRODUCTION
Which
Eversion endarterectomy: ?
EDB EE

10. Our study
CAROTID SURGERY A COMPARISON BETWEEN TWO TECHNIQUES A RANDOMIZED PROSPECTIVE STUDY ON RESTENOSIS RATE Domenico Palombo Vascular and Endovascular Unit A.O.U. San Martino – IST Genova Unviversity of Genova

11. Our study Technically challenging? Shunting more difficult?
Worst end-point visualization?
Longer operating and clamping time?
Lower re-stenosis rate?

12. Objective
OUR STUDY
The primary aim of our study is to evaluate and compare the rate of carotid restenosis between two groups of patients that underwent Eversion Endarterectomy.
First group eversion DeBakey technique
VERSUS
Second group eversion Etheredge technique

13. Objective
OUR STUDY
The secondary aim of our study is to evaluate and compare the rate of morbi-mortality and major neurological complications between two groups of patients that underwent Eversion Endarterectomy.

14. Materials and Methods Inclusion criteria: Patients older than 50 years
Planned admission to our ward to undergo carotid endarterectomy
OUR STUDY

15. Materials and Methods Exclusion criteria: Restenosis Hostile neck
Anatomical features :
Kinking of internal carotid artery
High carotid artery bifurcation
OUR STUDY

16. Materials and Methods TYPE OF TREATMENT OUR STUDY
All the patients were administered a
preoperatory duplex ultrasound of the
Carotid Arteries, in order to establish the
feasibility of both surgeries. Once the
patient was deemed fit for the enlistment,
he/she was random assigned to one of the
two groups
TYPE OF TREATMENT
Eversion endarterectomy
According to DeBakey
Eversion endarterectomy
According to Etheredge

17. Materials and Methods Personal Data Case history data
Perioperatory clinical data: about the state of neck blood vessels (evaluation of near-occlusion/ occlusion or kinking of vertebral and carotid arteries of both sides), possible cerebral symptoms (TIA, amaurosis, stroke), about the surgery (stump pressure, duration of clamping, possible use of shunt, monitoring of blood pressure)
Post-operatory clinical data
Follow up: clinical data
Follow up: tecnical data
OUR STUDY

18. Materials and Methods RESTENOSIS DEGREE: <50% mild
OUR STUDY
RESTENOSIS DEGREE:
<50% mild
≥50%-70% moderate
70% a99% serious
Reintervention: restenosis >80%
This evaluation has been made with duplex ultrasound, using the ECST parameters, and correlating this measurements with PSV

19. Materials and Methods
To calculate the required number of patients it was used the Chi-square statistical test
(alfa 0.05, power 80%). The statistical formula used is Pocock’s.
NUMBER OF SUBJECTS TO ENLIST
136 each group.
A total of 272 patients to enlist
OUR STUDY

20. Materials and Methods Surgical Procedure General Anesthesia
Stump Pressure Check
Cerebral/Somatic Oximeter (INVOS)
Quality control with duplex ultrasound intraoperatively after surgery
OUR STUDY

21. Materials and Methods Technically challenging?
Shunting more difficult?
Worst end-point visualization?
Longer operating and clamping time?
Lower re-stenosis rate?

22. Preliminary Results January 2010- October 2013
A total of 272 patients to enlist
Patients Enlisted 254
254
135
119

23. * Pz with stroke or tia within 6 months before surgery
Preliminar Results January October 2013
EVERSION DeBakey
PATIENTS 135
EVERSION Etheredge
PATIENTS 119
FEMALE
31,9%
25,2%
MALE
68,1%
74,8%
EVERSION DeBakey
PATIENTS 135
EVERSION Etheredge
PATIENTS 119
SYMPTOMATIC *
8,9%
10,1%
ASYMPTOMATIC
91,1%
89,9%
* Pz with stroke or tia within 6 months before surgery

24. Mean duration of clamping (min)
Preliminary Results January October 2013
Surgery data
EVERSION DeBakey
EVERSION Etheredge p
Mean duration of clamping (min)
43,94
44,74
Shunt (%)
4,4%
1,6%
0 , 8 (N.S.)
Stump pressure: > or < mmHg

25. Preliminary Results January 2010- October 2013
Difference in shunt use for De Bakey eversion vs Etheredge eversion was not statistically significant.

26. Morbi-mortality and major neurological complication
Preliminary Results January October 2013
Morbi-mortality and major neurological complication
30 DAYS
DE BAKEY EVERSION GROUP PZ
1 Cerebral hyperperfusion syndrome (0,9%)
1 Stroke (0,9%)
1 Respiratory distress syndrome (0,9%)
ETHEREDGE EVERSION GROUP PZ
none
Difference in morbi-mortality and major complications of DeBakey eversion vs Etheredge was not statistically significant.

27. Preliminary Results January 2010- October 2013
Re-stenosi > 70 %
12-month follow-up on 205 patient DB ET
12 Months
4 (3,79%)
3 (2,66%)
n.s

28. Overall number of patient re-treated at 12 months FU
Preliminary Results January October 2013
12-month follow-up on 205 patient
Indication to treatment if re-stenosis > 80%
3 patients re-treated
6 months
2 patients re-treated
12 months
Overall number of patient re-treated at 12 months FU
5 pt

29. Preliminary Results January 2010- October 2013
Results showed:
Technical feasibility
Comparable morbi-mortality rate
Comparable restenosis rate
Comparable operating time

30. Not be the first to use the new, Not be the last to leave the old
Pope Alessandro VIII