RecruitingNCT06722222

Gao's Triple Eversion Carotid Endarterectomy

A New Surgical Method for Treating Tandem Carotid Lesions: Gao's Triple Eversion Carotid Endarterectomy

Sponsor

Second Affiliated Hospital, School of Medicine, Zhejiang University

Enrollment

11 participants

Start Date

Sep 17, 2021

Study Type

OBSERVATIONAL

Conditions

Carotid Artery Stenosis

Summary

Carotid endarterectomy (CEA), an important surgical approach for managing carotid plaque, has evolved over more than 70 years but still cannot be applied to all tandem carotid lesions (TCLs) because of the wide range of these lesions. Herein, the investigators introduce an innovative CEA, Gao's triple eversion CEA (GTE-CEA), for the treatment of TCLs.

Eligibility

Inclusion Criteria2

Meet the diagnostic criteria for TCL stenosis.
Above 70% asymptomatic CCA and ICA stenosis or > 50% symptomatic CAS confirmed by DSA or CTA before surgery

Exclusion Criteria3

Did not meet the diagnostic criteria for CAS
Asymptomatic CAS < 50% (as confirmed by DSA or CTA before surgery)
With stenosis at the opening of the CCA.

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Interventions

PROCEDUREGao's triple eversion carotid endarterectomy

The carotid sheath is dissected in front of the sternocleidomastoid muscle to expose sufficient lengths of the CCA, ECA, and ICA. After raising the systolic blood pressure to 180 mmHg and intravenously injecting 1 mg/kg heparin, the superior thyroid artery is lapped and severed, and the CCA is occluded proximally to the CCA plaque, based on the plaque location shown by preoperative CTA and by intraoperative arterial exploration. Subsequently, the ECA and ICA are blocked individually. The ICA is cut diagonally at the CCA fork and the ECA is transected approximately 5 mm above its beginning. The plaque is removed with tweezers after eversion of the ICA. This process is repeated for the ECA. Finally, the long segment of plaque in the CCA is stripped proximally, followed by thorough removal of the debris on the peeling surface using heparin irrigation.