From Feasibility to Comparative Effectiveness in Exoscopic Carotid Endarterectomy

Q: What is the clinical evidence from this study?

Study design: Letter. Population: Asymptomatic carotid stenosis (n=44). Intervention: Exoscopic carotid endarterectomy vs. Conventional microscopic carotid endarterectomy. Primary outcome: Perioperative symptomatic stroke, ipsilateral cerebral infarction within 1 year, and permanent cranial nerve palsy.

Yasin TAŞKIN

doi:10.2176/jns-nmc.2026-0293

January 1, 2026Neurologia medico-chirurgicaOpen Access

From Feasibility to Comparative Effectiveness in Exoscopic Carotid Endarterectomy

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Key result

Exoscopic carotid endarterectomy yields 0% perioperative stroke or cranial nerve palsy in small initial series.

n=44

Key Points

To critically evaluate the methodological framework, statistical interpretation, and comparative outcomes between exoscopic and conventional microscopic carotid endarterectomy for asymptomatic carotid stenosis.
Critical commentary evaluating a comparative surgical series of 21 exoscopic carotid endarterectomies (performed 2018–2024) and 23 conventional microscopic procedures (performed 2012–2018) for asymptomatic carotid stenosis.
Methodological appraisal focused on statistical equivalence versus zero-event reporting, temporal confounding, operative phase durations, ergonomic assessments, and indocyanine green (ICG) dosing protocols.
No perioperative symptomatic strokes, ipsilateral cerebral infarctions within 1 year, or permanent cranial nerve palsies occurred in either group; applying the rule of three reveals an upper 95% confidence limit for complication rates of 14% for exoscopic (0 of 21) and 13% for microscopic (0 of 23) procedures.
Microsurgical time was significantly shorter in the exoscopic group, but neither total operative time nor total time in the operating room differed significantly between the groups.
A lower total ICG dose was administered despite more frequent injections in the exoscopic group, while ergonomic advantages remained unquantified by objective postural metrics.

PICO

P

Population

44 patients with asymptomatic carotid stenosis undergoing exoscopic (n=21) or conventional microscopic (n=23) carotid endarterectomy, followed for 1 year.

E

Exposure / Comparator

Exoscopic carotid endarterectomy vs Conventional microscopic carotid endarterectomy

O

Primary Outcome

Perioperative symptomatic stroke, ipsilateral cerebral infarction within 1 year, and permanent cranial nerve palsy

Main Result

Absolute Event Rate: 0% vs 0%

Limitations

Small sample size (21 exoscopic vs 23 microscopic procedures) prevents establishing statistical equivalence or noninferiority, with upper 95% confidence limits for complication rates around 13-14%.
Susceptibility to temporal confounding, as microscopic procedures were performed in 2012-2018 and exoscopic procedures in 2018-2024.
Shorter microsurgical time in the exoscopic group did not translate into a significant reduction in total operative time or total operating-room time.
Surgical ergonomics were not objectively quantified.
Lack of standardized reporting in milligrams and objective image-quality criteria for indocyanine green (ICG) administration.

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Implication

Small exoscopic CEA series with zero events should not alter practice; leaves open comparative safety and ergonomics versus microscopy.

Abstract

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Cite This Study

Yasin TAŞKIN (2026) conducted a letter in Asymptomatic carotid stenosis (n=44). Exoscopic carotid endarterectomy vs. Conventional microscopic carotid endarterectomy was evaluated on Perioperative symptomatic stroke, ipsilateral cerebral infarction within 1 year, and permanent cranial nerve palsy. Exoscopic carotid endarterectomy resulted in 0% perioperative stroke or cranial nerve palsy among 21 procedures, though the small sample leaves an approximate upper 95% confidence limit of 14%.

synapsesocial.com/papers/6af88e250e4d8f4b089c1c9f https://doi.org/10.2176/jns-nmc.2026-0293

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From Feasibility to Comparative Effectiveness in Exoscopic Carotid Endarterectomy

Key Points

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

From Feasibility to Comparative Effectiveness in Exoscopic Carotid Endarterectomy

Key Points

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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