Effectiveness of simultaneous longitudinal incision of the external carotid artery in standardized carotid endarterectomy

Objective: To evaluate the safety and effectiveness of longitudinal incision of external carotid artery(ECA) during standardized carotid endarterectomy(CEA). Materials and methods: A retrospective study was conducted on 30 patients with simultaneous internal and external carotid artery stenosis who were evaluated by carotid ultrasound and Transcranial Doppler(TCD) and neck CT angiography(CTA) or DSA in Liaocheng Second People's Hospital from January 2020 to January 2022. All patients underwent internal and external carotid endarterectomy under intraoperative TCD monitoring. Carotid ultrasound and TCD reexaminations were performed 3 months, 12 months, and 18 months post operation. Restenosis of the carotid artery and cerebral blood perfusion were evaluated. Results: There were 22 men and 8 women in 30 cases,including 2 cases with mild stenosis of the ECA, 15 cases with moderate stenosis, and 13 cases with severe stenosis. All patients underwent surgeries smoothly and no perioperative complications occurred. There were no cases with stenosis in 3 months, 3 cases present stenosis in 12 months, and 3 cases present stenosis in 18 months post operation. Cerebral ischemia stroke occurred 18 months after surgery in 1 case. Cerebral blood perfusion improved in all patients after surgery. The restenosis rate of the carotid arteries was 16.7% and the ischemic stroke rate was 3.3% after 18 months’ follow-up. Conclusion: Simultaneous longitudinal incision of the ECA in standardized carotid endarterectomy is a safe and effective surgical method. It not only restores the normal anatomical structure of the external carotid artery, but also effectively hinder carotid artery restenosis and occlusion rate, improves cerebral blood perfusion especially in patients with poor compensation of intracranial collateral circulation, and thus reduces the occurrence of ischemic stroke events.