Carotid endarterectomy: the optimal surgical technique from the point of view of cardiologist

BACKGROUND: The aim of this study is to determine the rational tactics of carotid endarterectomy (CEA) technique in patients with bilateral operation.METHODS: Forty-seven patients underwent CEA at the second side. It was performed in two different ways: by the eversion technique or by the classical technique, with obligatory preservation of the carotid glomus. In group I (N.=24) we included patients whom the CEA on the second side was performed in eversion technique; group II (N.=23), in classical technique. All patients underwent laboratory tests, ECG, chest X-ray, ultrasound of kidneys, computer tomography (CT) of adrenal glands, brain CT, echocardiography, ultrasound or angiography of renal arteries, coronary angiography. Before and after CEA on the second side, all patients underwent Doppler ultrasound of brachiocephalic arteries and 24-hour blood pressure (BP) monitoring. We analyzed the influence of the CEA on the course of AH in all patients.RESULTS: Groups of patients I and II were identical in gender, age, anamnesis, concomitant diseases, duration of surgery, as well as the 24-hours BP monitoring main parameters. After the CEA on the second side the 24-hour BP monitoring parameters changed: mean systolic BP (SBP) and diastolic BP (DBP) per 24-hour, maximum SBP and DBP, variability of SBP and DBP, time index for SBP and DBP decreased. The decrease in BP was more prominent in group II.CONCLUSIONS: If it is necessary to perform the CEA operation in the patient on the second side, the operation of choice is CEA in the classical technique with the obligatory preservation of the carotid glomus.