Double Eversion Carotid Endarterectomy of Tandem Carotid Lesions

Background: We describe an original method to treat tandem lesions of the internal carotid artery (ICA) and the common carotid artery (CCA). In this manuscript, we describe a "double eversion carotid endarterectomy" technique (DECE) and report our results. Methods: A retrospective review in the medical records of patients that underwent DECE over a 15-year period was performed. Patient characteristics, operative details, preoperative imaging and lesion characteristics, perioperative outcomes, and follow-up data were documented and analyzed. Patients with ostial and mediastinal lesions were excluded from our study. Operations were divided into 2 categories: "planned," when the lesions were identified during preoperative imaging, and "necessary" when performed for secondary defects of the CCA detected intraoperatively. Results: Between 1996 and 2011, a total of 15 patients with 17 tandem lesions underwent DECE. The mean age was 74.3 years. The mean degree of stenosis was 76.3% for the ICA and 61.5% for the CCA, with the majority of the lesions being asymptomatic (12/17). All procedures were performed under general anesthesia, and in 1 case an intraluminal shunt was used. The mean operative time was 83.4 min, with a mean primary clamping time of 29.2 min. In cases of secondary lesions, the mean reclamping time was 16.2 min. There was no mortality or major neurologic event within 30 days postoperatively. Postoperative complications included 2 major cardiac events and 1 case of cranial nerve XII injury that resolved during follow-up. There were no deaths or neurologic events during a mean follow-up of 27.5 months (range: 1-188 months). One patient required a reintervention after 5 years because of restenosis of the ICA. Conclusion: DECE is an alternative surgical technique for select tandem, nonostial carotid lesions. In addition, DECE can be performed as a "bailout" procedure for secondary CCA defects during conventional eversion carotid endarterectomy.