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Pros and cons of conventional vs eversion CEA balance out over long term

Reuters Health • The Doctor's Channel Daily Newscast

Early neurologic outcomes are better with conventional carotid endarterectomy (CEA) than eversion CEA, but the eversion technique may be more effective for preventing stroke over the long term, investigators report

As such, “outcome of the techniques is similar at the 2-year time point,” conclude the authors of the report in the July issue of Stroke published online April 10.

Dr. Serdar Demirel, with the University Hospital of Ruprecht Karls in Heidelberg, Germany, and colleagues explain that either longitudinal arteriotomy (conventional) or an eversion approach is used for carotid endarterectomy, but the ideal technique has not been determined.

To compare outcomes with the two procedures, the team looked at data from the surgical arm of the SPACE-1 trial, in which 310 patients underwent conventional CEA and 206 had eversion CEA.

In that cohort, ipsilateral stroke or death within 30 days occurred in 3% of the conventional CEA group compared with 9% of the eversion CEA group (p=0.005), according to the report. Intraoperative ipsilateral stroke occurred in 0.3% and 4.0% of the two groups, respectively (p=0.0035).

However, 2-year rates of stroke occurring later than 30 days after the procedure were 2.9% in the conventional CEA arm versus 0% in the eversion arm (p=0.017), the investigators report.

“When periprocedural outcomes were included in the 2-year outcome parameters, no significant difference in stroke and death rates was detectable between the 2 groups,” Dr. Demirel and colleagues conclude.

However, they advise, “These findings should be interpreted with caution noting the limitations of the post hoc, nonrandomized nature of the analysis.”

Multicenter Experience on Eversion Versus Conventional Carotid Endarterectomy in Symptomatic Carotid Artery Stenosis