UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Carotid endarterectomy

Author
Ronald M Fairman, MD
Section Editors
John F Eidt, MD
Joseph L Mills, Sr, MD
Scott E Kasner, MD
Emile R Mohler III, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

Treatment aimed at carotid atherosclerotic lesions may be beneficial for symptomatic or asymptomatic patients. This topic will review the preoperative evaluation and surgical technique of carotid endarterectomy (CEA). The indications for carotid revascularization and perioperative stroke risk assessment for patients with carotid atherosclerosis are discussed elsewhere. (See "Management of asymptomatic carotid atherosclerotic disease" and "Management of symptomatic carotid atherosclerotic disease".)

Carotid artery stenting is also discussed separately. (See "Carotid artery stenting and its complications".)

INDICATIONS

The effectiveness of carotid endarterectomy (CEA) in the management of selected patients with symptomatic or asymptomatic carotid atherosclerotic disease has been established by large randomized clinical trials. The specific indications for CEA are discussed in detail elsewhere. (See "Management of symptomatic carotid atherosclerotic disease", section on 'Carotid endarterectomy' and "Management of asymptomatic carotid atherosclerotic disease", section on 'Carotid endarterectomy'.)

Special considerations

Bilateral carotid stenosis — Some patients have varying degrees of bilateral carotid disease. No randomized clinical trials have evaluated the effectiveness of bilateral CEA for such patients. However, bilateral carotid occlusive disease appears to increase the risk for complications during and after unilateral CEA [1-4]. As an example, in one study of 700 patients undergoing CEA, 15.4 percent had contralateral disease [2]. The combined death and stroke rates in these patients were almost twice that of matched patients with unilateral disease (5.6 versus 2.4 percent).

The impact of severe contralateral carotid artery stenosis or occlusion on the benefit and risk of unilateral CEA in patients with symptomatic and asymptomatic disease is discussed separately in the appropriate topic reviews. (See "Management of symptomatic carotid atherosclerotic disease", section on 'Contralateral carotid stenosis or occlusion' and "Management of asymptomatic carotid atherosclerotic disease", section on 'Contralateral carotid stenosis or occlusion'.)

                                          

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Mon Nov 21 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Counsell CE, Salinas R, Naylor R, Warlow CP. A systematic review of the randomised trials of carotid patch angioplasty in carotid endarterectomy. Eur J Vasc Endovasc Surg 1997; 13:345.
  2. da Silva AF, McCollum P, Szymanska T, de Cossart L. Prospective study of carotid endarterectomy and contralateral carotid occlusion. Br J Surg 1996; 83:1370.
  3. Gasecki AP, Eliasziw M, Ferguson GG, et al. Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. J Neurosurg 1995; 83:778.
  4. Faggioli G, Pini R, Mauro R, et al. Contralateral carotid occlusion in endovascular and surgical carotid revascularization: a single centre experience with literature review and meta-analysis. Eur J Vasc Endovasc Surg 2013; 46:10.
  5. Parikh S, Cohen JR. Perioperative stroke after general surgical procedures. N Y State J Med 1993; 93:162.
  6. Landercasper J, Merz BJ, Cogbill TH, et al. Perioperative stroke risk in 173 consecutive patients with a past history of stroke. Arch Surg 1990; 125:986.
  7. Larsen SF, Zaric D, Boysen G. Postoperative cerebrovascular accidents in general surgery. Acta Anaesthesiol Scand 1988; 32:698.
  8. Ropper AH, Wechsler LR, Wilson LS. Carotid bruit and the risk of stroke in elective surgery. N Engl J Med 1982; 307:1388.
  9. Evans BA, Wijdicks EF. High-grade carotid stenosis detected before general surgery: is endarterectomy indicated? Neurology 2001; 57:1328.
  10. Ballotta E. High-grade carotid stenosis detected before general surgery: is endarterectomy indicated? Neurology 2002; 58:1442.
  11. Khan UA, Thapar A, Shalhoub J, Davies AH. Risk of intracerebral aneurysm rupture during carotid revascularization. J Vasc Surg 2012; 56:1739.
  12. Marcucci G, Accrocca F, Antonelli R, et al. High-risk patients for carotid endarterectomy: turned down cases are rare. J Cardiovasc Surg (Torino) 2012; 53:333.
  13. Okawa M, Ogata T, Abe H, et al. Do octogenarians still have a high risk of adverse outcomes after carotid endarterectomy in the era of a super-aged society? A single-center study in Japan. J Stroke Cerebrovasc Dis 2015; 24:370.
  14. Gasparis AP, Ricotta L, Cuadra SA, et al. High-risk carotid endarterectomy: fact or fiction. J Vasc Surg 2003; 37:40.
  15. Flanigan DP, Flanigan ME, Dorne AL, et al. Long-term results of 442 consecutive, standardized carotid endarterectomy procedures in standard-risk and high-risk patients. J Vasc Surg 2007; 46:876.
  16. Brott TG, Brown RD Jr, Meyer FB, et al. Carotid revascularization for prevention of stroke: carotid endarterectomy and carotid artery stenting. Mayo Clin Proc 2004; 79:1197.
  17. LaMuraglia GM, Brewster DC, Moncure AC, et al. Carotid endarterectomy at the millennium: what interventional therapy must match. Ann Surg 2004; 240:535.
  18. Magnadottir HB, Lightdale N, Harbaugh RE. Clinical outcomes for patients at high risk who underwent carotid endarterectomy with regional anesthesia. Neurosurgery 1999; 45:786.
  19. Antoniou GA, Kuhan G, Sfyroeras GS, et al. Contralateral occlusion of the internal carotid artery increases the risk of patients undergoing carotid endarterectomy. J Vasc Surg 2013; 57:1134.
  20. Jørgensen ME, Torp-Pedersen C, Gislason GH, et al. Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery. JAMA 2014; 312:269.
  21. Salomon du Mont L, Ravelojaona M, Puyraveau M, et al. Carotid endarterectomy in octogenarian: short- and midterm results. Ann Vasc Surg 2014; 28:917.
  22. Sharpe R, Sayers RD, London NJ, et al. Procedural risk following carotid endarterectomy in the hyperacute period after onset of symptoms. Eur J Vasc Endovasc Surg 2013; 46:519.
  23. Wallaert JB, Cronenwett JL, Bertges DJ, et al. Optimal selection of asymptomatic patients for carotid endarterectomy based on predicted 5-year survival. J Vasc Surg 2013; 58:112.
  24. Rajamani K, Kennedy KF, Ruggiero NJ, et al. Outcomes of carotid endarterectomy in the elderly: report from the National Cardiovascular Data Registry. Stroke 2013; 44:1172.
  25. Bekelis K, Bakhoum SF, Desai A, et al. A risk factor-based predictive model of outcomes in carotid endarterectomy: the National Surgical Quality Improvement Program 2005-2010. Stroke 2013; 44:1085.
  26. Wallaert JB, De Martino RR, Finlayson SR, et al. Carotid endarterectomy in asymptomatic patients with limited life expectancy. Stroke 2012; 43:1781.
  27. Goodney PP, Likosky DS, Cronenwett JL, Vascular Study Group of Northern New England. Factors associated with stroke or death after carotid endarterectomy in Northern New England. J Vasc Surg 2008; 48:1139.
  28. Hannan EL, Popp AJ, Feustel P, et al. Association of surgical specialty and processes of care with patient outcomes for carotid endarterectomy. Stroke 2001; 32:2890.
  29. Kragsterman B, Logason K, Ahari A, et al. Risk factors for complications after carotid endarterectomy--a population-based study. Eur J Vasc Endovasc Surg 2004; 28:98.
  30. Wong JH, Findlay JM, Suarez-Almazor ME. Regional performance of carotid endarterectomy. Appropriateness, outcomes, and risk factors for complications. Stroke 1997; 28:891.
  31. Reed AB, Gaccione P, Belkin M, et al. Preoperative risk factors for carotid endarterectomy: defining the patient at high risk. J Vasc Surg 2003; 37:1191.
  32. Bennett KM, Scarborough JE, Shortell CK. Predictors of 30-day postoperative stroke or death after carotid endarterectomy using the 2012 carotid endarterectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database. J Vasc Surg 2015; 61:103.
  33. Hsia DC, Moscoe LM, Krushat WM. Epidemiology of carotid endarterectomy among Medicare beneficiaries: 1985-1996 update. Stroke 1998; 29:346.
  34. Ouriel K, Hertzer NR, Beven EG, et al. Preprocedural risk stratification: identifying an appropriate population for carotid stenting. J Vasc Surg 2001; 33:728.
  35. Mozes G, Sullivan TM, Torres-Russotto DR, et al. Carotid endarterectomy in SAPPHIRE-eligible high-risk patients: implications for selecting patients for carotid angioplasty and stenting. J Vasc Surg 2004; 39:958.
  36. Piepgras DG, Sundt TM Jr, Marsh WR, et al. Recurrent carotid stenosis. Results and complications of 57 operations. Ann Surg 1986; 203:205.
  37. Miller MT, Comerota AJ, Tzilinis A, et al. Carotid endarterectomy in octogenarians: does increased age indicate "high risk?". J Vasc Surg 2005; 41:231.
  38. Halm EA, Hannan EL, Rojas M, et al. Clinical and operative predictors of outcomes of carotid endarterectomy. J Vasc Surg 2005; 42:420.
  39. Howard G, Roubin GS, Jansen O, et al. Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trials. Lancet 2016; 387:1305.
  40. Frego M, Bridda A, Ruffolo C, et al. The hostile neck does not increase the risk of carotid endarterectomy. J Vasc Surg 2009; 50:40.
  41. Bouziane Z, Nourissat G, Duprey A, et al. Carotid artery surgery: high-risk patients or high-risk centers? Ann Vasc Surg 2012; 26:790.
  42. Jordan WD Jr, Alcocer F, Wirthlin DJ, et al. High-risk carotid endarterectomy: challenges for carotid stent protocols. J Vasc Surg 2002; 35:16.
  43. Kang JL, Chung TK, Lancaster RT, et al. Outcomes after carotid endarterectomy: is there a high-risk population? A National Surgical Quality Improvement Program report. J Vasc Surg 2009; 49:331.
  44. Hill BB, Olcott C 4th, Dalman RL, et al. Reoperation for carotid stenosis is as safe as primary carotid endarterectomy. J Vasc Surg 1999; 30:26.
  45. Jackson RS, Black JH 3rd, Lum YW, et al. Class I obesity is paradoxically associated with decreased risk of postoperative stroke after carotid endarterectomy. J Vasc Surg 2012; 55:1306.
  46. Ballotta E, Da Giau G, Ermani M, et al. Early and long-term outcomes of carotid endarterectomy in the very elderly: an 18-year single-center study. J Vasc Surg 2009; 50:518.
  47. Baracchini C, Saladini M, Lorenzetti R, et al. Gender-based outcomes after eversion carotid endarterectomy from 1998 to 2009. J Vasc Surg 2012; 55:338.
  48. Dorigo W, Pulli R, Marek J, et al. Carotid endarterectomy in female patients. J Vasc Surg 2009; 50:1301.
  49. Rockman CB, Garg K, Jacobowitz GR, et al. Outcome of carotid artery interventions among female patients, 2004 to 2005. J Vasc Surg 2011; 53:1457.
  50. Yavas S, Mavioglu L, Kocabeyoglu S, et al. Is female gender really a risk factor for carotid endarterectomy? Ann Vasc Surg 2010; 24:775.
  51. den Hartog AG, Algra A, Moll FL, de Borst GJ. Mechanisms of gender-related outcome differences after carotid endarterectomy. J Vasc Surg 2010; 52:1062.
  52. Bisdas T, Egorova N, Moskowitz AJ, et al. The impact of gender on in-hospital outcomes after carotid endarterectomy or stenting. Eur J Vasc Endovasc Surg 2012; 44:244.
  53. Qureshi AI, Chaudhry SA, Qureshi MH, Suri MF. Rates and predictors of 5-year survival in a national cohort of asymptomatic elderly patients undergoing carotid revascularization. Neurosurgery 2015; 76:34.
  54. Illuminati G, Schneider F, Greco C, et al. Long-term results of a randomized controlled trial analyzing the role of systematic pre-operative coronary angiography before elective carotid endarterectomy in patients with asymptomatic coronary artery disease. Eur J Vasc Endovasc Surg 2015; 49:366.
  55. Eagle KA, Boucher CA. Cardiac risk of noncardiac surgery. N Engl J Med 1989; 321:1330.
  56. Greco G, Egorova NN, Moskowitz AJ, et al. A model for predicting the risk of carotid artery disease. Ann Surg 2013; 257:1168.
  57. Johnston DC, Goldstein LB. Clinical carotid endarterectomy decision making: noninvasive vascular imaging versus angiography. Neurology 2001; 56:1009.
  58. Qureshi AI, Suri MF, Ali Z, et al. Role of conventional angiography in evaluation of patients with carotid artery stenosis demonstrated by Doppler ultrasound in general practice. Stroke 2001; 32:2287.
  59. Silvennoinen HM, Ikonen S, Soinne L, et al. CT angiographic analysis of carotid artery stenosis: comparison of manual assessment, semiautomatic vessel analysis, and digital subtraction angiography. AJNR Am J Neuroradiol 2007; 28:97.
  60. Kahlon B, Sundbärg G, Rehncrona S. Comparison between the lumbar infusion and CSF tap tests to predict outcome after shunt surgery in suspected normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 2002; 73:721.
  61. Patel SG, Collie DA, Wardlaw JM, et al. Outcome, observer reliability, and patient preferences if CTA, MRA, or Doppler ultrasound were used, individually or together, instead of digital subtraction angiography before carotid endarterectomy. J Neurol Neurosurg Psychiatry 2002; 73:21.
  62. Grant EG, Benson CB, Moneta GL, et al. Carotid artery stenosis: gray-scale and Doppler US diagnosis--Society of Radiologists in Ultrasound Consensus Conference. Radiology 2003; 229:340.
  63. Johnston DC, Chapman KM, Goldstein LB. Low rate of complications of cerebral angiography in routine clinical practice. Neurology 2001; 57:2012.
  64. Ballotta E, Toniato A, Da Roit A, Baracchini C. Clinical Outcomes of Carotid Endarterectomy in Symptomatic and Asymptomatic Patients with Ipsilateral Intracranial Stenosis. World J Surg 2015; 39:2823.
  65. Lee EJ, Cho YP, Lee SH, et al. Hemodynamic Tandem Intracranial Lesions on Magnetic Resonance Angiography in Patients Undergoing Carotid Endarterectomy. J Am Heart Assoc 2016; 5.
  66. Kappelle LJ, Eliasziw M, Fox AJ, et al. Importance of intracranial atherosclerotic disease in patients with symptomatic stenosis of the internal carotid artery. The North American Symptomatic Carotid Endarterectomy Trail. Stroke 1999; 30:282.
  67. Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. BMJ 1994; 308:81.
  68. Engelter S, Lyrer P. Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy. Cochrane Database Syst Rev 2003; :CD001458.
  69. Lindblad B, Persson NH, Takolander R, Bergqvist D. Does low-dose acetylsalicylic acid prevent stroke after carotid surgery? A double-blind, placebo-controlled randomized trial. Stroke 1993; 24:1125.
  70. Chaturvedi S, Bruno A, Feasby T, et al. Carotid endarterectomy--an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2005; 65:794.
  71. Taylor DW, Barnett HJ, Haynes RB, et al. Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: a randomised controlled trial. ASA and Carotid Endarterectomy (ACE) Trial Collaborators. Lancet 1999; 353:2179.
  72. Alonso-Coello P, Bellmunt S, McGorrian C, et al. Antithrombotic therapy in peripheral artery disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e669S.
  73. Payne DA, Jones CI, Hayes PD, et al. Beneficial effects of clopidogrel combined with aspirin in reducing cerebral emboli in patients undergoing carotid endarterectomy. Circulation 2004; 109:1476.
  74. Huibers A, Halliday A, Bulbulia R, et al. Antiplatelet Therapy in Carotid Artery Stenting and Carotid Endarterectomy in the Asymptomatic Carotid Surgery Trial-2. Eur J Vasc Endovasc Surg 2016; 51:336.
  75. de Borst GJ, Hilgevoord AA, de Vries JP, et al. Influence of antiplatelet therapy on cerebral micro-emboli after carotid endarterectomy using postoperative transcranial Doppler monitoring. Eur J Vasc Endovasc Surg 2007; 34:135.
  76. Jones DW, Goodney PP, Conrad MF, et al. Dual antiplatelet therapy reduces stroke but increases bleeding at the time of carotid endarterectomy. J Vasc Surg 2016; 63:1262.
  77. Kennedy J, Quan H, Buchan AM, et al. Statins are associated with better outcomes after carotid endarterectomy in symptomatic patients. Stroke 2005; 36:2072.
  78. McGirt MJ, Perler BA, Brooke BS, et al. 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors reduce the risk of perioperative stroke and mortality after carotid endarterectomy. J Vasc Surg 2005; 42:829.
  79. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195.
  80. Cavalcanti DD, Reis CV, Hanel R, et al. The ascending pharyngeal artery and its relevance for neurosurgical and endovascular procedures. Neurosurgery 2009; 65:114.
  81. Demirci M, Saribaş O, Uluç K, et al. Carotid artery stenting and endarterectomy have different effects on heart rate variability. J Neurol Sci 2006; 241:45.
  82. Demirel S, Attigah N, Bruijnen H, et al. Changes in baroreceptor sensitivity after eversion carotid endarterectomy. J Vasc Surg 2012; 55:1322.
  83. Demirel S, Macek L, Bruijnen H, et al. Eversion carotid endarterectomy is associated with decreased baroreceptor sensitivity compared to the conventional technique. Eur J Vasc Endovasc Surg 2012; 44:1.
  84. GALA Trial Collaborative Group, Lewis SC, Warlow CP, et al. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. Lancet 2008; 372:2132.
  85. Leichtle SW, Mouawad NJ, Welch K, et al. Outcomes of carotid endarterectomy under general and regional anesthesia from the American College of Surgeons' National Surgical Quality Improvement Program. J Vasc Surg 2012; 56:81.
  86. Rerkasem K, Rothwell PM. Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst Rev 2008; :CD000126.
  87. Schechter MA, Shortell CK, Scarborough JE. Regional versus general anesthesia for carotid endarterectomy: the American College of Surgeons National Surgical Quality Improvement Program perspective. Surgery 2012; 152:309.
  88. Gürer O, Yapıcı F, Yapıcı N, et al. Comparison between local and general anesthesia for carotid endarterectomy: early and late results. Vasc Endovascular Surg 2012; 46:131.
  89. Vaniyapong T, Chongruksut W, Rerkasem K. Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst Rev 2013; :CD000126.
  90. Gomes M, Soares MO, Dumville JC, et al. Cost-effectiveness analysis of general anaesthesia versus local anaesthesia for carotid surgery (GALA Trial). Br J Surg 2010; 97:1218.
  91. McCarthy RJ, Walker R, McAteer P, et al. Patient and hospital benefits of local anaesthesia for carotid endarterectomy. Eur J Vasc Endovasc Surg 2001; 22:13.
  92. Rerkasem K, Rothwell PM. Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Cochrane Database Syst Rev 2009; :CD000190.
  93. Marcucci G, Antonelli R, Gabrielli R, et al. Short longitudinal versus transverse skin incision for carotid endarterectomy: impact on cranial and cervical nerve injuries and esthetic outcome. J Cardiovasc Surg (Torino) 2011; 52:145.
  94. Hertzer NR, Beven EG, Greenstreet RL, Humphries AW. Internal carotid back pressure, intraoperative shunting, ulcerated atheromata, and the incidence of stroke during carotid endarterectomy. Surgery 1978; 83:306.
  95. Demirel S, Attigah N, Bruijnen H, et al. Eversion carotid endarterectomy is associated with impaired postoperative hemodynamic stability compared with the conventional technique. Ann Vasc Surg 2012; 26:755.
  96. Fearn SJ, Parry AD, Picton AJ, et al. Should heparin be reversed after carotid endarterectomy? A randomised prospective trial. Eur J Vasc Endovasc Surg 1997; 13:394.
  97. Stone DH, Nolan BW, Schanzer A, et al. Protamine reduces bleeding complications associated with carotid endarterectomy without increasing the risk of stroke. J Vasc Surg 2010; 51:559.
  98. Newhall KA, Saunders EC, Larson RJ, et al. Use of Protamine for Anticoagulation During Carotid Endarterectomy: A Meta-analysis. JAMA Surg 2016; 151:247.
  99. Sharpe R, Sayers RD, McCarthy MJ, et al. The war against error: a 15 year experience of completion angioscopy following carotid endarterectomy. Eur J Vasc Endovasc Surg 2012; 43:139.
  100. Walker RA, Fox AD, Magee TR, Horrocks M. Intraoperative duplex scanning as a means of quality control during carotid endarterectomy. Eur J Vasc Endovasc Surg 1996; 11:364.
  101. Padayachee TS, Brooks MD, Modaresi KB, et al. Intraoperative high resolution duplex imaging during carotid endarterectomy: which abnormalities require surgical correction? Eur J Vasc Endovasc Surg 1998; 15:387.
  102. Panneton JM, Berger MW, Lewis BD, et al. Intraoperative duplex ultrasound during carotid endarterectomy. Vasc Surg 2001; 35:1.
  103. Wallaert JB, Goodney PP, Vignati JJ, et al. Completion imaging after carotid endarterectomy in the Vascular Study Group of New England. J Vasc Surg 2011; 54:376.
  104. Ricco JB, Régnault de la Mothe G, Fujita S, et al. Impact of routine completion angiography on the results of primary carotid endarterectomy: a prospective study in a teaching hospital. Eur J Vasc Endovasc Surg 2011; 41:579.
  105. Ascher E, Markevich N, Kallakuri S, et al. Intraoperative carotid artery duplex scanning in a modern series of 650 consecutive primary endarterectomy procedures. J Vasc Surg 2004; 39:416.
  106. Mullenix PS, Tollefson DF, Olsen SB, et al. Intraoperative duplex ultrasonography as an adjunct to technical excellence in 100 consecutive carotid endarterectomies. Am J Surg 2003; 185:445.
  107. Ott C, Heller G, Odermatt M, Furrer M. Intraoperative duplex ultrasonography in carotid endarterectomy: the impact on indication for immediate revision and intermediate-term outcome. Vasa 2008; 37:151.
  108. Zannetti S, Cao P, De Rango P, et al. Intraoperative assessment of technical perfection in carotid endarterectomy: a prospective analysis of 1305 completion procedures. Collaborators of the EVEREST study group. Eversion versus standard carotid endartectomy. Eur J Vasc Endovasc Surg 1999; 18:52.
  109. Lingenfelter KA, Fuller BC, Sullivan TM. Intraoperative assessment of carotid endarterectomy: a comparison of techniques. Ann Vasc Surg 1995; 9:235.
  110. Jain KM, Simoni EJ, Munn JS. Routine completion study during carotid endarterectomy is not necessary. Am J Surg 1994; 168:163.
  111. Ricotta JJ, O'Brien-Irr MS. Completion angiography, is it really necessary? Am J Surg 1997; 174:181.
  112. Kumar S, Lombardi JV, Alexander JB, et al. Modified eversion carotid endarterectomy. Ann Vasc Surg 2013; 27:178.
  113. Cao P, Giordano G, De Rango P, et al. A randomized study on eversion versus standard carotid endarterectomy: study design and preliminary results: the Everest Trial. J Vasc Surg 1998; 27:595.
  114. Markovic DM, Davidovic LB, Cvetkovic DD, et al. Single-center prospective, randomized analysis of conventional and eversion carotid endarterectomy. J Cardiovasc Surg (Torino) 2008; 49:619.
  115. Ballotta E, Renon L, Da Giau G, et al. A prospective randomized study on bilateral carotid endarterectomy: patching versus eversion. Ann Surg 2000; 232:119.
  116. Ballotta E, Da Giau G, Saladini M, et al. Carotid endarterectomy with patch closure versus carotid eversion endarterectomy and reimplantation: a prospective randomized study. Surgery 1999; 125:271.
  117. Balzer, K. Eversion versus conventional endarterectomy. In: Perioperative monitoring in carotid surgery, Horsch, S, Ktenidis, K. (Eds), Steinkopff Spinger, Darmstadt 1998. p.159-165.
  118. Cao P, Giordano G, De Rango P, et al. Eversion versus conventional carotid endarterectomy: late results of a prospective multicenter randomized trial. J Vasc Surg 2000; 31:19.
  119. Vanmaele RG, Van Schil PE, DeMaeseneer MG, et al. Division-endarterectomy-anastomosis of the internal carotid artery: a prospective randomized comparative study. Cardiovasc Surg 1994; 2:573.
  120. Antonopoulos CN, Kakisis JD, Sergentanis TN, Liapis CD. Eversion versus conventional carotid endarterectomy: a meta-analysis of randomised and non-randomised studies. Eur J Vasc Endovasc Surg 2011; 42:751.
  121. Ballotta E, Toniato A, Da Giau G, et al. Durability of eversion carotid endarterectomy. J Vasc Surg 2014; 59:1274.
  122. Demirel S, Attigah N, Bruijnen H, et al. Multicenter experience on eversion versus conventional carotid endarterectomy in symptomatic carotid artery stenosis: observations from the Stent-Protected Angioplasty Versus Carotid Endarterectomy (SPACE-1) trial. Stroke 2012; 43:1865.
  123. Cao PG, de Rango P, Zannetti S, et al. Eversion versus conventional carotid endarterectomy for preventing stroke. Cochrane Database Syst Rev 2001; :CD001921.
  124. Brothers TE. Initial experience with eversion carotid endarterectomy: absence of a learning curve for the first 100 patients. J Vasc Surg 2005; 42:429.
  125. Stone PA, AbuRahma AF, Mousa AY, et al. Prospective randomized trial of ACUSEAL versus Vascu-Guard patching in carotid endarterectomy. Ann Vasc Surg 2014; 28:1530.
  126. AbuRahma AF, Hannay RS, Khan JH, et al. Prospective randomized study of carotid endarterectomy with polytetrafluoroethylene versus collagen-impregnated Dacron (Hemashield) patching: perioperative (30-day) results. J Vasc Surg 2002; 35:125.
  127. AbuRahma AF, Hopkins ES, Robinson PA, et al. Prospective randomized trial of carotid endarterectomy with polytetrafluoroethylene versus collagen-impregnated dacron (Hemashield) patching: late follow-up. Ann Surg 2003; 237:885.
  128. Kim JH, Cho YP, Kwon TW, et al. Ten-year comparative analysis of bovine pericardium and autogenous vein for patch angioplasty in patients undergoing carotid endarterectomy. Ann Vasc Surg 2012; 26:353.
  129. Rerkasem K, Rothwell PM. Patches of different types for carotid patch angioplasty. Cochrane Database Syst Rev 2010; :CD000071.
  130. AbuRahma AF, Robinson PA, Saiedy S, et al. Prospective randomized trial of carotid endarterectomy with primary closure and patch angioplasty with saphenous vein, jugular vein, and polytetrafluoroethylene: long-term follow-up. J Vasc Surg 1998; 27:222.
  131. Rerkasem K, Rothwell PM. Patch angioplasty versus primary closure for carotid endarterectomy. Cochrane Database Syst Rev 2009; :CD000160.
  132. AbuRahma AF, Khan JH, Robinson PA, et al. Prospective randomized trial of carotid endarterectomy with primary closure and patch angioplasty with saphenous vein, jugular vein, and polytetrafluoroethylene: perioperative (30-day) results. J Vasc Surg 1996; 24:998.
  133. González-Fajardo JA, Pérez JL, Mateo AM. Saphenous vein patch versus polytetrafluoroethylene patch after carotid endarterectomy. J Cardiovasc Surg (Torino) 1994; 35:523.
  134. Hayes PD, Allroggen H, Steel S, et al. Randomized trial of vein versus Dacron patching during carotid endarterectomy: influence of patch type on postoperative embolization. J Vasc Surg 2001; 33:994.
  135. Ho KJ, Nguyen LL, Menard MT. Intermediate-term outcome of carotid endarterectomy with bovine pericardial patch closure compared with Dacron patch and primary closure. J Vasc Surg 2012; 55:708.
  136. Blume WT, Ferguson GG, McNeill DK. Significance of EEG changes at carotid endarterectomy. Stroke 1986; 17:891.
  137. Chongruksut W, Vaniyapong T, Rerkasem K. Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Cochrane Database Syst Rev 2014; :CD000190.
  138. Halsey JH Jr. Risks and benefits of shunting in carotid endarterectomy. The International Transcranial Doppler Collaborators. Stroke 1992; 23:1583.
  139. Whitney DG, Kahn EM, Estes JW, Jones CE. Carotid artery surgery without a temporary indwelling shunt. 1,917 consecutive procedures. Arch Surg 1980; 115:1393.
  140. Bond R, Rerkasem K, Counsell C, et al. Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Cochrane Database Syst Rev 2002; :CD000190.
  141. Goodney PP, Wallaert JB, Scali ST, et al. Impact of practice patterns in shunt use during carotid endarterectomy with contralateral carotid occlusion. J Vasc Surg 2012; 55:61.
  142. Kretz B, Abello N, Astruc K, et al. Influence of the contralateral carotid artery on carotid surgery outcome. Ann Vasc Surg 2012; 26:766.
  143. Tan TW, Garcia-Toca M, Marcaccio EJ Jr, et al. Predictors of shunt during carotid endarterectomy with routine electroencephalography monitoring. J Vasc Surg 2009; 49:1374.
  144. Aburahma AF, Mousa AY, Stone PA. Shunting during carotid endarterectomy. J Vasc Surg 2011; 54:1502.
  145. Kretz B, Abello N, Bouchot O, et al. Risk index for predicting shunt in carotid endarterectomy. Ann Vasc Surg 2014; 28:1204.
  146. Matsumoto GH, Cossman D, Callow AD. Hazards and safeguards during carotid endarterectomy. Technical considerations. Am J Surg 1977; 133:458.
  147. Wennberg DE, Lucas FL, Birkmeyer JD, et al. Variation in carotid endarterectomy mortality in the Medicare population: trial hospitals, volume, and patient characteristics. JAMA 1998; 279:1278.
  148. Brott T, Thalinger K. The practice of carotid endarterectomy in a large metropolitan area. Stroke 1984; 15:950.
  149. Barnett HJ, Plum F, Walton JN. Carotid endarterectomy--an expression of concern. Stroke 1984; 15:941.
  150. O'Neill L, Lanska DJ, Hartz A. Surgeon characteristics associated with mortality and morbidity following carotid endarterectomy. Neurology 2000; 55:773.
  151. Kumamaru H, Jalbert JJ, Nguyen LL, et al. Surgeon case volume and 30-day mortality after carotid endarterectomy among contemporary medicare beneficiaries: before and after national coverage determination for carotid artery stenting. Stroke 2015; 46:1288.
  152. Galiñanes EL, Dombroviskiy VY, Hupp CS, et al. Evaluation of readmission rates for carotid endarterectomy versus carotid artery stenting in the US Medicare population. Vasc Endovascular Surg 2014; 48:217.
  153. Fokkema M, Bensley RP, Lo RC, et al. In-hospital versus postdischarge adverse events following carotid endarterectomy. J Vasc Surg 2013; 57:1568.