Key result
Modified eversion CEA with autologous patch yields 0% 30-day major cardiovascular events and no late restenosis.
Why the study?
Internal carotid artery kinking associated with significant carotid stenosis can complicate carotid endarterectomy and contribute to cerebrovascular symptoms, motivating the evaluation of a modified eversion CEA technique with ICA shortening and autologous arterial patch reconstruction.
Does modified eversion carotid endarterectomy using an autologous arterial patch reduce 30-day major adverse cardiovascular events and 12-month restenosis compared to conventional carotid endarterectomy in patients with significant carotid stenosis and internal carotid artery kinking?
Cohort (n=33)
No
Does modified eversion carotid endarterectomy using an autologous arterial patch reduce 30-day major adverse cardiovascular events and 12-month restenosis compared to conventional carotid endarterectomy in patients with significant carotid stenosis and internal carotid artery kinking?
Answers are grounded in this paper and cite their sources.
Modified eversion carotid endarterectomy reusing the resected kinked internal carotid artery segment as an autologous patch is a technically feasible option for patients with carotid stenosis and kinking, demonstrating no 30-day MACE, restenosis ≥50%, or kinking recurrence at 14-month follow-up in this small preliminary cohort.
Background Internal carotid artery (ICA) kinking, especially when associated with significant carotid stenosis, can complicate carotid endarterectomy (CEA) and contribute to cerebrovascular symptoms. We evaluated a modified eversion CEA technique involving ICA shortening and reconstruction with an autologous arterial patch prepared from the resected ICA segment. Methods This single-center retrospective study included 33 patients who underwent CEA due to significant carotid stenosis and had a confirmed ICA kinking by computed tomography angiography between 2020 and 2025. Kinking severity was graded using the Metz angle. Twenty-two patients underwent conventional CEA, and 11 patients underwent modified eversion CEA with ICA shortening and autologous arterial patch reconstruction. Results The mean age was 67.5 ± 8.0 years, and 69% of the patients were male. The mean NASCET stenosis was 74 ± 10%, and the mean Metz angle was 56° ± 17°. The 30-day rate of major adverse cardiovascular events was 0%. Transient cranial nerve injury occurred in 12%, hyperperfusion syndrome in 3%, and reoperation due to cervical hematoma in 3%. The mean cross-clamp time was 24 ± 7 min, and the mean operative time was 94 ± 20 min. At a mean follow-up of 14 ± 4 months, restenosis ≥50% occurred in 15% of patients, restenosis ≥70% in 3%, and kinking recurrence in 6%. In the modified eversion group, no restenosis ≥50%, kinking recurrence, or carotid aneurysm was observed. Conclusions Modified eversion CEA using an autologous arterial patch appears to be a technically feasible reconstructive option for selected patients with ICA kinking. These findings should be interpreted as preliminary because of the retrospective design, small sample size, and limited follow-up. Larger prospective studies are needed to determine durability and comparative effectiveness.
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Kaya et al. (2026) conducted a cohort in Internal carotid artery kinking and significant carotid stenosis (n=33). Modified eversion carotid endarterectomy with ICA shortening and autologous arterial patch reconstruction vs. Conventional carotid endarterectomy (standard longitudinal arteriotomy with primary closure or PTFE/Dacron/venous patch angioplasty) was evaluated on 30-day major adverse cardiovascular events (stroke, myocardial infarction, death) and >=50% restenosis at 12 months. Modified eversion carotid endarterectomy with an autologous arterial patch resulted in 0% 30-day major cardiovascular events, 0% restenosis >=50%, and 0% kinking recurrence over a mean 14-month follow-up.
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