IYSC10 - Partial Eversion Endarterectomy is a safe and effective technical alternative to conventional carotid revascularization

Thursday, June 11, 2026

4:15 PM - 4:20 PM ET

Location: Hynes CC, Third Level, Room 309

Submitting & Presenting Author(s)

Andrea Vacirca, MD, PhD (he/him/his)

Vascular Surgeon
University of Bologna
Bologna

Co-Author(s)

Gianluca Faggioli, MD, PhD

Full Professor
Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Bologna, Italy
AP

Alessandra Porcelli

Resident
University of Bologna
MM

Marco Mattiacci

Resident
University of Bologna, Italy
SC

Stefania Caputo

Emilia-Romagna, Italy
Rodolfo Pini, MD, PhD

University Researcher
Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Bologna, Italy
ML

Marcello Lodato, MD

Consultant in Vascular Surgery
University of Bologna
Bologna, Emilia-Romagna, Italy
Stefano Ancetti

Vascular Surgeon
Department of Vascular Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Bologna, Italy
MB

Maria Giovanna Bonanno

Vascular Surgeon
Department of Vascular Surgery, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Enrico Gallitto, MD, PhD

Associate Professor
Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Bologna, Italy

Senior Author(s)

MG

Mauro Gargiulo

Ordinary Professor
Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Bologna

Objectives: Partial eversion (PE-CEA) is a modified version of complete eversion carotid endarterectomy (E-CEA). Since its first decription in 2017, few studies have reported its outcomes or compared them with conventional carotid endarterectomy techniques.
Aim of the study was to compare the outcomes of PE-CEA with those of patch carotid endarterectomy (Patch-CEA) and E-CEA in a large single-center experience.

Methods: A retrospective analysis of carotid endarterectomies performed at a single center between January 2005 and December 2025 was conducted. All procedures were performed under general anesthesia with cerebral oximetry monitoring. Techniques included patch-CEA using Dacron or bovine pericardial patch, complete E-CEA, and PE-CEA (see Figures 1 and 2). Shunting was used routinely in patch-CEA and selectively in E-CEA and PE-CEA. The surgical approach was selected based on plaque characteristics on preoperative imaging and surgeon preference. Primary endpoints were 30-day neurological events and mortality. During follow-up, survival and restenosis >70% were assessed. Statistical analysis included chi-square test, one-way ANOVA, linear regression, and log-rank test.

Results: Overall, 1,918 patients underwent carotid endarterectomy (38% female, mean age 72±9 years). Four-hundred-sixty-one/1,918 patients (24%) were symptomatic. Patch-CEA was performed in 1,599 patients (83%), E-CEA in 175 (9%), and PE-CEA in 144 (8%). Patch-CEA had a significantly lower mean age compared with E-CEA and PE-CEA groups (71±8 vs 75±9 vs 73±9 years, respectively; p<.001) and a lower prevalence of dyslipidemia (82% vs 88% vs 87%, respectively; p=.04). Symptomatic stenosis and former smoking were less frequent in PE-CEA than in Patch-CEA and E-CEA groups (16% vs 24% vs 30%, p=.01; and 16% vs 27% vs 38%, p<.001).
Thirty-day mortality was 0.3%, with no significant differences among groups (0.3% in Patch-CEA vs 0.6% in E-CEA vs 0% in PE-CEA; p=.66). The overall 30-day TIA/stroke rate was 2%, and was similar across techniques (2% Patch-CEA vs 2% E-CEA vs 1% PE-CEA, p=.47). After adjustment for confounders, PE-CEA was not independently associated with 30-day mortality [OR 0.11 (CI 0.02-1.55), p=.99] or TIA/stroke [OR 0.33 (CI 0.04-2.51), p=.28].
At a mean follow-up of 45±33 months, the overall survival was 90±2%, with no differences among groups (p=.38). Freedom from >70% restenosis was comparable across techniques (95±5% Patch-CEA vs 97±2% E-CEA vs 100% PE-CEA, p=.33).

Conclusions: Partial eversion carotid endarterectomy provides short- and mid-term outcomes comparable to patch and complete eversion techniques, with low perioperative morbidity and excellent freedom from restenosis. These results support PE-CEA as a safe and effective alternative carotid revascularization strategy in selected patients.