Arteriotomy for Carotid Endarterectomy, from Common to Interna or Externa?

Objective: Carotid endarterectomy is an evolving and changing procedure over its almost 70 years history. Surgery is commonly described as a total removal of plaques from the carotid tree maintained via an arteriotomy from common carotid artery to internal carotid artery. We aim to express our opinion that an incision to external carotid artery may always provide adequate reach to a plaque of internal carotid artery side. So, there is no need of internal carotid artery involvement during arteriotomy. Materials and Methods: 73 patients were included to study. All patients underwent single-sided Carotid Endarterectomy. Group A (n=61) and Group B (n=12). Group A included our primary cases Carotid Endarterectomy with artery incision Common Carotid Artery to External Carotid Artery in 61 patients. Group B patients of 12 cases received an artery incision from Common Carotid Artery to Internal Carotid Artery. Results: 2 patients in Group A (3.2%) and 2 patients (16.6%) in Group B died at the early postoperative period due to severe neurological deteriorations in 3 (4.1%) and myocardial infarction in 1 (1.3%) case, p 0.05 (SS, statistically significant). Overall mortality was 4 cases by 5.4%. None of these patients were presenting contralateral serious carotid artery lesions. 4 patients (6.5%) from Group A and 3 patients (25%) from Group B were receiving haemodialysis, perioperatively p 0.05 (SS, statistically significant). Transcient minor neurological complications such as lingual deviation and/or facial asymmetry which were associated with N.Hypoglossus injuries, was observed in 8 cases and 2 cases in Group A (10.9%) and Group B (16.6%), respectively (p 0.05 statistically non-significant) . Conclusion: By this Common Carotid Artery to External Carotid Artery running arteriotomy, it is possible to avoid intraoperative Internal Carotid Artery narrowing and endothelial deterioration which may cause early and/or late intraluminal thrombosis tendency. For carotid endarterectomy arteriotomy, we always prefer common to externa.