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PubMed · 10769443

[Eversion endarterectomy--out?].

D Raithel·C Schunn
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Abstract

Carotid eversion endarterectomy has become a well established alternative to conventional carotid endarterectomy. Similar perioperative morbidity and mortality results have been documented in several large clinical series. Our experience with carotid reconstructive surgery consists of 12,596 operations between 8/84 and 12/97, some 60% of which were performed using the eversion technique. Transient or permanent neurologic deficit was observed in 2.0%; 0.8% died after the procedure. Eversion endarterectomy should only be performed under suitable anatomic conditions. It is a challenging technique which requires advanced surgical skills and sound clinical judgement. The long-term rate of restenosis seems to be influenced favourably after eversion endarterectomy.

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Blood Vessel Prosthesis ImplantationCarotid StenosisContraindicationsEndarterectomy, CarotidFollow-Up StudiesHumansPostoperative ComplicationsProspective StudiesRandomized Controlled Trials as TopicRecurrenceTime FactorsJournal Article

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D Raithel, C Schunn. 2000. [Eversion endarterectomy--out?].. https://pubmed.ncbi.nlm.nih.gov/10769443/

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Comparison of outcomes (early and six- month) of direct stenting with conventional stenting (a meta-analysis of ten randomized trials).

Although direct stenting (DS) is increasingly used in clinical practice instead of stent implantation after predilatation (conventional stenting [CS]), its impact has not been scientifically proved. We therefore performed, using Mantel-Haenszel analysis, a meta-analysis of the published randomized studies comparing DS with CS. Furthermore, all the key procedural data were systematically sought out and pooled. Ten trials (2,650 coronary lesions, 2,576 patients) were identified and entered into the analysis. Adopted angiographic exclusion criteria were homogeneous. DS, compared with CS, was found to have a similar success rate (98.7% vs 98.9%) and no specific complications. Across the studies, the mean rate of crossover to predilatation in the DS arm was 5.9%. Overall, DS was associated with a 17% procedural time (95% confidence interval [CI] 14% to 20%), a 18% fluoroscopic time (95% CI 15% to 21%), a 11% contrast volume (95% CI 9% to 14%), and a 22% cost reduction (95% CI 16% to 28%). In the early postintervention period, DS was associated with a trend toward reduction of each of the major adverse events (MACEs) and with a significant reduction of myocardial infarction (MI) + death (odds ratio [OR] 0.57, 95% CI 0.35 to 0.95). However, at 6 months, the OR (95% CI) for death, MI, target lesion revascularization, and MACEs were 0.47 (0.19 to 1.27), 0.72 (0.45 to 1.25), 1.07 (0.77 to 1.46), and 0.82 (0.63 to 1.08), respectively. In the subgroup of studies providing quantitative angiographic data, all the parameters were found to be similar between the CS and DS groups. In conclusion, the present meta-analysis shows that DS compared with CS, in selected coronary lesions, is safe, optimizes equipment use, and may enhance the early results of coronary interventions while warranting similar late clinical outcomes.

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