Do we really need patch and shunt for carotid endarterectomy?

Aim: The efficacy of carotid endarterectomy (CEA) for stroke prevention in asymptomatic and symptomatic patients is well known. We aimed to share long term follow up results for primary closure technique for CEA without shunting and investigated risk factors for complications in this patient group. Material and Methods: Between September 2013-2019, 122 patients with isolated CEA with primary closure were enrolled in this retrospective study. Dopppler ultrasound (DUSG) scanning was used as the primary imaging tool for the determination of residual and recurrent stenosis. During the follow-up period duplex ultrasonography was performed in the second month, sixth month and annually thereafter. Ipsilateral cerebrovascular events and mortalities were recorded during follow up period. Results: The mean age was 69,1 ± 7,1 (48-90) years. The median follow-up time was 47 (5 to 78) months. Hospital mortality was reported in 1 patient (0,8%). Early postoperative cerebrovascular accident were seen as ipsilateral disabling stroke in 1 patient (0,8%), ipsilateral non-disabling stroke in 1 patient (0,8%), reversible ischemic neurological deficit (RIND) in 1 patient (0,8%) and massive intracranial bleeding in 1 patient (0,8%). Late mortality was reported in 4 (3,3%) patients. 2 (1,6%) were cardiac reasons and 2 (1,6%) were non cardiac reasons. During the follow-up period ipsilateral cerebrovascular accident (CVA) were seen in 3 patients (2,5%) and these were; ipsilateral disabling stroke in 1 patient (0,8%), ipsilateral non-disabling stroke in 1 patient (0,8%), RIND in 1 patient (0,8%).According to the latest duplex scanning during follow up period 4 (3,3%) patients had below 50% restenosis, 2 (1,7%) patients had above 70% restenosis and 1 (0,8%) patient had total occlusion. Conclusion: Primary closure technique for CEA can be used in selected patients with acceptable early and late complication rates, low mortality and low restenosis rate.