title: Durability of eversion carotid endarterectomy.
abstract: OBJECTIVE
  Carotid endarterectomy (CEA) remains the gold standard for treating carotid disease in selected symptomatic and asymptomatic patients, though carotid angioplasty and stenting has emerged as a safe alternative. The aim of this study was to assess the durability of CEA in a large series of patients followed up according to a strict clinical and ultrasonographic protocol.
  
  
  METHODS
  Over a 23-year period (1990-2012) a total of 1773 patients (1251 men and 522 women) with a mean age of 75.2 years (range, 31 to 96 years) who underwent 2007 consecutive primary eversion CEAs performed by the same surgeon under general anesthesia with electroencephalographic monitoring and selective shunting were prospectively followed up with ultrasonography at 1, 6, and 12 months, then yearly. A long-term follow-up (median, 11.2 years; mean, 12.9 years) was obtained for 1680 patients (94.8%). End points were perioperative (30-day) stroke and death and late carotid restenosis/occlusion rates.
  
  
  RESULTS
  More than two in three of the lesions (1446 of 2007, 72.1%) were symptomatic at the time of surgery, with a 25% rate of preoperative stroke. Preoperative antiplatelet or anticoagulant therapy was used by 1675 patients (94.4%), whereas 918 (51.8%) were receiving statin treatment. Overall, there were eight (0.4%) perioperative strokes and no deaths. During the follow-up, there were nine (0.47%) asymptomatic late carotid restenoses (six moderate [50%-69%] and three severe [≥ 70%]) and one (0.05%) carotid occlusion. Nine patients (0.47%) had late ipsilateral strokes, none of them related to restenosis/occlusion. Overall, there were 159 late deaths (9.4%).
  
  
  CONCLUSIONS
  The results of this study show that eversion CEA can be performed in symptomatic and asymptomatic patients with an extremely low perioperative stroke/death risk and a negligible incidence of late restenosis/occlusion, thus assuring a persistently good protection against the risk of cerebral ischemia.
authors.affiliation: Vascular Surgery Group, 2nd Surgical Clinic, Department of Surgical, Oncological, and Gastroenterological Sciences at the University of Padua, School of Medicine, Padova, Italy. Electronic address: enzo.ballotta@unipd.it.
authors.forename: Enzo
authors.initials: E
authors.lastname: Ballotta
authors.affiliation: Vascular Surgery Group, 2nd Surgical Clinic, Department of Surgical, Oncological, and Gastroenterological Sciences at the University of Padua, School of Medicine, Padova, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Toniato
authors.affiliation: Vascular Surgery Group, 2nd Surgical Clinic, Department of Surgical, Oncological, and Gastroenterological Sciences at the University of Padua, School of Medicine, Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Da Giau
authors.affiliation: Vascular Surgery Group, 2nd Surgical Clinic, Department of Surgical, Oncological, and Gastroenterological Sciences at the University of Padua, School of Medicine, Padova, Italy.
authors.forename: Renata
authors.initials: R
authors.lastname: Lorenzetti
authors.affiliation: Vascular Surgery Group, 2nd Surgical Clinic, Department of Surgical, Oncological, and Gastroenterological Sciences at the University of Padua, School of Medicine, Padova, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Da Roit
authors.affiliation: Department of Neurosciences at the University of Padua, School of Medicine, Padova, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Baracchini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000925:Anticoagulants / Q000627:therapeutic use; D058070:Asymptomatic Diseases; D002545:Brain Ischemia / Q000209:etiology / Q000401:mortality; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D004569:Electroencephalography; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000925:Anticoagulants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors