Modified eversion carotid endarterectomy using an autologous arterial patch for internal carotid artery kinking: early clinical outcomes

Background Internal carotid artery (ICA) kinking, especially when associated with significant carotid stenosis, can complicate carotid endarterectomy (CEA) and contribute to cerebrovascular symptoms. We evaluated a modified eversion CEA technique involving ICA shortening and reconstruction with an autologous arterial patch prepared from the resected ICA segment. Methods This single-center retrospective study included 33 patients who underwent CEA due to significant carotid stenosis and had a confirmed ICA kinking by computed tomography angiography between 2020 and 2025. Kinking severity was graded using the Metz angle. Twenty-two patients underwent conventional CEA, and 11 patients underwent modified eversion CEA with ICA shortening and autologous arterial patch reconstruction. Results The mean age was 67.5 ± 8.0 years, and 69% of the patients were male. The mean NASCET stenosis was 74 ± 10%, and the mean Metz angle was 56° ± 17°. The 30-day rate of major adverse cardiovascular events was 0%. Transient cranial nerve injury occurred in 12%, hyperperfusion syndrome in 3%, and reoperation due to cervical hematoma in 3%. The mean cross-clamp time was 24 ± 7 min, and the mean operative time was 94 ± 20 min. At a mean follow-up of 14 ± 4 months, restenosis ≥50% occurred in 15% of patients, restenosis ≥70% in 3%, and kinking recurrence in 6%. In the modified eversion group, no restenosis ≥50%, kinking recurrence, or carotid aneurysm was observed. Conclusions Modified eversion CEA using an autologous arterial patch appears to be a technically feasible reconstructive option for selected patients with ICA kinking. These findings should be interpreted as preliminary because of the retrospective design, small sample size, and limited follow-up. Larger prospective studies are needed to determine durability and comparative effectiveness.