105. 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. 106. Balzer, K. Eversion versus conventional endarterectomy. In: Perioperative monitoring in car otid surgery, Horsch, S, Ktenidis, K (Eds), Steinkopff Spinger, Darmstadt 1998. p.159-165. 107. 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. 108. 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. 109. 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. 110. Ballotta E, Toniato A, Da Giau G, et al. Durability of eversion carotid endarterectomy. J Vasc Surg 2014; 59:1274. https://www.uptodate.com/contents/carotid-endarterectomy/print 35/45 7/5/23, 11:36 AM Carotid endarterectomy - UpToDate 111. 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. 112. Cao PG, de Rango P, Zannetti S, et al. Eversion versus conventional carotid endarterectomy for preventing stroke. Cochrane Database Syst Rev 2001; :CD001921. 113. Brothers TE. Initial experience with eversion carotid endarterectomy: absence of a learning curve for the first 100 patients. J Vasc Surg 2005; 42:429. 114. Demirel S, Goossen K, Bruijnen H, et al. Systematic review and meta-analysis of postcarotid endarterectomy hypertension after eversion versus conventional carotid endarterectomy. J Vasc Surg 2017; 65:868. 115. Lazarides MK, Christaina E, Argyriou C, et al. Editor's Choice - Network Meta-Analysis of Carotid Endarterectomy Closure Techniques. Eur J Vasc Endovasc Surg 2021; 61:181. 116. Orrapin S, Benyakorn T, Howard DP, et al. Patches of different types for carotid patch angioplasty. Cochrane Database Syst Rev 2021; 2:CD000071. 117. Huizing E, Vos CG, van den Akker PJ, et al. A systematic review of patch angioplasty versus primary closure for carotid endarterectomy. J Vasc Surg 2019; 69:1962. 118. 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. 119. 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. 120. 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. 121. 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. 122. Zaza SI, Bennett KM. The role of patch closure in current-day carotid endarterectomy. J Vasc Surg 2023; 77:170. 123. 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. https://www.uptodate.com/contents/carotid-endarterectomy/print 36/45 7/5/23, 11:36 AM Carotid endarterectomy - UpToDate 124. Rerkasem K, Rothwell PM. Patch angioplasty versus primary closure for carotid endarterectomy. Cochrane Database Syst Rev 2009; :CD000160. 125. 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. 126. Gonz lez-Fajardo JA, P rez JL, Mateo AM. Saphenous vein patch versus polytetrafluoroethylene patch after carotid endarterectomy. J Cardiovasc Surg (Torino) 1994; 35:523. 127. 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. 128. 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. 129. Blume WT, Ferguson GG, McNeill DK. Significance of EEG changes at carotid endarterectomy. Stroke 1986; 17:891. 130. Palombo D, Lucertini G, Mambrini S, Zettin M. Subtle cerebral damage after shunting vs non shunting during carotid endarterectomy. Eur J Vasc Endovasc Surg 2007; 34:546. 131. Gumerlock MK, Neuwelt EA. Carotid endarterectomy: to shunt or not to shunt. Stroke 1988; 19:1485. 132. Sandmann W, Kolvenbach R, Willeke F. Risks and benefits of shunting in carotid endarterectomy. Stroke 1993; 24:1098. 133. Chuatrakoon B, Nantakool S, Rerkasem A, et al. Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Cochrane Database Syst Rev 2022; 6:CD000190. 134. Halsey JH Jr. Risks and benefits of shunting in carotid endarterectomy. The International Transcranial Doppler Collaborators. Stroke 1992; 23:1583. 135. 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. 136. Squizzato F, Siracuse JJ, Shuja F, et al. Impact of Shunting Practice Patterns During Carotid Endarterectomy for Symptomatic Carotid Stenosis. Stroke 2022; 53:2230. 137. Aburahma AF, Stone PA, Hass SM, et al. Prospective randomized trial of routine versus selective shunting in carotid endarterectomy based on stump pressure. J Vasc Surg 2010; 51:1133. https://www.uptodate.com/contents/carotid-endarterectomy/print 37/45 7/5/23, 11:36 AM Carotid endarterectomy - UpToDate 138. Aburahma AF, Mousa AY, Stone PA. Shunting during carotid endarterectomy. J Vasc Surg 2011; 54:1502. 139. 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. 140. Kretz B, Abello N, Astruc K, et al. Influence of the contralateral carotid artery on carotid surgery outcome. Ann Vasc Surg 2012; 26:766. 141. 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. 142. Rerkasem A, Orrapin S, Howard DP, et al. Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst Rev 2021; 10:CD000126. 143. Matsumoto GH, Cossman D, Callow AD. Hazards and safeguards during carotid endarterectomy. Technical considerations. Am J Surg 1977; 133:458. 144. 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. 145. Brott T, Thalinger K. The practice of carotid endarterectomy in a large metropolitan area. Stroke 1984; 15:950. 146. Barnett HJ, Plum F, Walton JN. Carotid endarterectomy an expression of concern. Stroke 1984; 15:941. 147. O'Neill L, Lanska DJ, Hartz A. Surgeon characteristics associated with mortality and morbidity following carotid endarterectomy. Neurology 2000; 55:773. 148. 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. 149. Schermerhorn ML, Fokkema M, Goodney P, et al. The impact of Centers for Medicare and Medicaid Services high-risk criteria on outcome after carotid endarterectomy and carotid artery stenting in the SVS Vascular Registry. J Vasc Surg 2013; 57:1318. 150. Rao V, Liang P, Swerdlow N, et al. Contemporary outcomes after carotid endarterectomy in high-risk anatomic and physiologic patients. J Vasc Surg 2020; 71:104. 151. Hicks CW, Nejim B, Locham S, et al. Association between Medicare high-risk criteria and outcomes after carotid revascularization procedures. J Vasc Surg 2018; 67:1752. 152. Lokuge K, de Waard DD, Halliday A, et al. Meta-analysis of the procedural risks of carotid endarterectomy and carotid artery stenting over time. Br J Surg 2018; 105:26. https://www.uptodate.com/contents/carotid-endarterectomy/print 38/45 7/5/23, 11:36 AM Carotid endarterectomy - UpToDate 153. Gali anes 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. 154. Fokkema M, Bensley RP, Lo RC, et al. In-hospital versus postdischarge adverse events following carotid endarterectomy. J Vasc Surg 2013; 57:1568. Topic 8193 Version 46.0 https://www.uptodate.com/contents/carotid-endarterectomy/print 39/45 7/5/23, 11:36 AM Carotid endarterectomy - UpToDate GRAPHICS Antimicrobial prophylaxis for vascular surgery in adults Nature of Common Recommended Usual adult Redose operation pathogens antimicrobials dose* interval Arterial surgery Staphylococcus Cefazolin <120 kg: 2 g IV 4 hours involving a prosthesis, the aureus, S. epidermidis, 120 kg: 3 g IV OR vancomycin 15 mg/kg IV (max N/A abdominal aorta, enteric gram- 2 g) or a groin incision negative bacilli OR clindamycin 900 mg IV 6 hours Lower extremity amputation for S. aureus, S. epidermidis, Cefazolin <120 kg: 2 g IV 4 hours 120 kg: 3 g IV ischemia enteric gram- OR vancomycin 15 mg/kg IV (max 2 g) N/A negative bacilli, clostridia OR clindamycin 900 mg IV 6 hours IV: intravenous. Parenteral prophylactic antimicrobials can be given as a single IV dose begun within 60 minutes before the procedure. If vancomycin is used, the infusion should be started within 60 to 120 minutes before the initial incision to have adequate tissue levels at the time of incision and to minimize the possibility of an infusion reaction close to the time of induction of anesthesia. For prolonged procedures (>3 hours) or those with major blood loss, or in patients with extensive burns, additional intraoperative doses should be given at intervals one to two times the half-life of the drug for the duration of the procedure in patients with normal renal function. Use of vancomycin is appropriate in hospitals in which methicillin-resistant S. aureus (MRSA) and S. epidermidis are a frequent cause of postoperative wound infection, in patients previously colonized with methicillin-resistant S. aureus, or for those who are allergic to penicillins or cephalosporins. Rapid IV administration may cause hypotension, which could be especially dangerous during induction of anesthesia. Even when the drug is given over 60 minutes, hypotension may occur; treatment with diphenhydramine and further slowing of the infusion rate may be helpful. For procedures in which enteric gram-negative bacilli are common pathogens, many experts would add another drug such as an aminoglycoside (such as gentamicin 5 mg/kg IV), aztreonam (2 g), or a fluoroquinolone (such as ciprofloxacin 400 mg IV or levofloxacin 500 mg IV). Adapted from: 1. Antimicrobial prophylaxis for surgery. Med Lett Drugs Ther 2016; 58:63. 2. Bratzler DW, et al. Clinical guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73. Graphic 87206 Version 11.0 https://www.uptodate.com/contents/carotid-endarterectomy/print 40/45 7/5/23, 11:36 AM Carotid endarterectomy - UpToDate Anatomy of the cerebral arterial circulation Frontal view of the carotid arteries, vertebral arteries, and intracranial vessels and their communication with each other via the circle of Willis. Reproduced with permission from: U acker R. Atlas Of Vascular Anatomy: An Angiographic Approach, Second Edition. Philadelphia: Lippincott Williams & Wilkins, 2006. Copyright 2006 Lippincott Williams & Wilkins. Graphic 51410 Version 6.0 https://www.uptodate.com/contents/carotid-endarterectomy/print 41/45 7/5/23, 11:36 AM Carotid endarterectomy - UpToDate Hypoglossal nerve Graphic 86991 Version 1.0 https://www.uptodate.com/contents/carotid-endarterectomy/print 42/45 7/5/23, 11:36 AM Carotid endarterectomy - UpToDate External carotid artery anatomy External carotid artery and its branches in the lateral view. Reproduced with permission from: U acker R. Atlas Of Vascular Anatomy: An Angiographic Approach, Second Edition. Philadelphia: Lippincott Williams & Wilkins, 2007. Copyright 2007 Lippincott Williams & Wilkins. Graphic 50495 Version 1.0 https://www.uptodate.com/contents/carotid-endarterectomy/print 43/45 7/5/23, 11:36 AM Carotid endarterectomy - UpToDate Lateral view of the internal carotid artery Lateral view of a schematic drawing of the carotid arteries, vertebral arteries, and intracranial vessels and their relationships in the neck and brain. Reproduced with permission from: U acker R. Atlas Of Vascular Anatomy: An Angiographic Approach, Second Edition. Philadelphia: Lippincott Williams & Wilkins, 2007. Copyright 2007 Lippincott Williams & Wilkins. Graphic 63286 Version 1.0 https://www.uptodate.com/contents/carotid-endarterectomy/print 44/45 7/5/23, 11:36 AM Carotid endarterectomy - UpToDate Contributor Disclosures Jeffrey Jim, MD, MPHS, FACS Consultant/Advisory Boards: Endospan [Aortic interventions]; Medtronic [Aortic interventions]; Silk Road Medical [Carotid stent]. All of the relevant financial relationships listed have been mitigated. John F Eidt, MD Grant/Research/Clinical Trial Support: Syntactx [Clinical events, data/safety monitoring for medical device trials]. All of the relevant financial relationships listed have been mitigated. Joseph L Mills, Sr, MD No relevant financial relationship(s) with ineligible companies to disclose. Scott E Kasner, MD Grant/Research/Clinical Trial Support: Bayer [Stroke]; Bristol Meyers Squibb [Stroke]; Medtronic [Stroke]; WL Gore and Associates [Stroke]. Consultant/Advisory Boards: Abbvie [Stroke]; AstraZeneca [Stroke]; BMS [Stroke]; Diamedica [Stroke]; Medtronic [Stroke]. All of the relevant financial relationships listed have been mitigated. Kathryn A Collins, MD, PhD, FACS No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/carotid-endarterectomy/print 45/45