Key result
CEA techniques continue evolving despite ongoing controversies over optimal incisions, shunting, and patching.
Why the study?
Carotid endarterectomy techniques have evolved over the last 60 years, warranting a review of recent literature on operational maneuvers and a discussion of future problems.
What are the current methods, benefits, and challenges associated with various surgical techniques for carotid endarterectomy?
What are the current methods, benefits, and challenges associated with various surgical techniques for carotid endarterectomy?
This review summarizes current surgical techniques for carotid endarterectomy, highlighting the benefits of patch angioplasty and multiple monitoring modalities while noting the need for improved training programs in low-volume settings like Japan.
CEA techniques continue evolving with less invasive options; leaves open standardization of maneuvers pending higher-level evidence.
Over the last 60 years, many reports have investigated carotid endarterectomy (CEA) and techniques have thus changed and improved. In this paper, we review the recent literature regarding operational maneuvers for CEA and discuss future problems for CEA. Longitudinal skin incision is common, but the transverse incision has been reported to offer minimal invasiveness and better cosmetic effects for CEA. Most surgeons currently use microscopy for dissection of the artery and plaque. Although no monitoring technique during CEA has been proven superior, multiple monitors offer better sensitivity for predicting postoperative neurological deficit. To date, data are lacking regarding whether routine shunt or selective shunt is better. Individual surgeons thus need to select the method with which they are more comfortable. Many surgical techniques have been reported to obtain distal control of the internal carotid artery in patients with high cervical carotid bifurcation or high plaque, and minimally invasive techniques should be considered. Multiple studies have shown that patch angioplasty reduces the risks of stroke and restenosis compared with primary closure, but few surgeons in Japan have been performing patch angioplasty. Most surgeons thus experience only a small volume of CEAs in Japan, so training programs and development of in vivo training models are important.
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Uno et al. (2020) conducted a review in Carotid artery stenosis. Carotid endarterectomy surgical techniques was evaluated. Carotid endarterectomy techniques have evolved over 60 years, though controversies remain regarding optimal skin incision, intraoperative monitoring, shunting, and patch angioplasty.
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