To explore the indications for the surgical techniques in microsurgical treatment for symptomatic carotid stenosis, and to compare the perioperative risk and the long-term efficacy between conventional carotid endarterectomy (C-CEA) and eversion CEA (E-CEA).

The clinical data of unilateral microscopic CEA surgeries in Qingdao University Affiliated Hospital from September 2013 to December 2019 were retrospectively analyzed. All patients presented with severe symptomatic carotid stenosis. Different CEA surgical techniques were applied according to the location of the main plaque and the morphology of internal carotid artery (ICA). According to different microscopic CEA techniques, patients were divided into the C-CEA group and the E-CEA group. The rank-sum test or chi-square test was used to compare the carotid cross-clamp time, perioperative complications, ICA restenosis during follow-up, and incidence of new-onset stroke between the two groups.

A total of 221 patients were identified, including 115 in the C-CEA group and 106 in the E-CEA group. The carotid cross-clamp time was 27.8 (23.6, 37.2) min in the C-CEA group and 26.5 (22.8, 35.1) min in the E-CEA group. There was no perioperative death. A total of 5 cases (2.26%) had severe periprocedural complications, including 2 cases (1.74%) in the C-CEA group and 3 (2.86%) in the E-CEA group, and there was no significant difference between the two groups. During the follow-up, 2 cases (1.74%) of ICA restenosis were found in the C-CEA group and 1 case (0.94%) in the E-CEA group. There was no new-onset cerebral infarction on the surgical side in both groups. There were no significant differences in all the above indicators between the two groups (P＞0.05). The incidence of transient cranial nerve injury during perioperative period in the E-CEA group was higher than that in the C-CEA group [8.49% (9/106) vs 1.74% (2/115), P=0.024].

Applying different CEA techniques according to plaque location and ICA morphology is a feasible surgical strategy. Although the E-CEA group had a higher incidence of transient cranial nerve injury during the perioperative period; C-CEA and E-CEA for symptomatic carotid stenosis can achieve equivalent therapeutic effects in terms of long-term recovery and efficacy .