Can Endarterectomy Of The External Carotid Artery Be Beneficial? A Critical Overview

Endarterectomy of the external carotid artery (eCEA) with an occlusion of the internal carotid artery (ICA) stump is a less common treatment option for patients with neurological or ocular symptoms associated with a chronic ipsilateral ICA occlusion and stenosis of the ECA in the carotid bifurcation. The aim was to update the latest and largest published overviews concerning the outcomes of eCEA and critically evaluate the potential benefit of eCEA based on the available data. The results of several previous observational studies have showed that eCEA might be beneficial in selected symptomatic patients with a chronic ipsilateral ICA occlusion and ECA stenosls; however, a recent randomized study did not confirm this. The findings of previous observational studies are limited due to their great heterogeneity, retrospective design and small sample size (Grade 1, Level of evidence C). Thus, clear evidence for the benefits of eCEA is still missing.