Introduction Modern surgery is increasingly moving towards mini-invasiveness for various reasons: it is less painful, involves a shorter hospital stay, and yields better aes- thetic results(1, 2). Carotid endarterectomy (CEA) prevents strokes in patients with severe carotid stenosis, as the numer- ous studies in the literature and the revision of the Cochrane Library witness (3-8). A mini-invasive access is also justified for carotid surgery (incision of 3-7 cm) after meticulous preoper- ative mapping for the precise identification of the bi- furcation site which leads to an accurate incision. Materials and methods At the Vascular Surgery Unit of Parma Universi- ty Hospital, in 2005 76 patients (Group A) underwent Carotid CEA; their personal, co-morbidity and clini- cal data are reported in Tables 1 and 2. All patients underwent a thorough preoperative B-mode duplex ultrasound scanning examination (G E medical sys- tems logic™book XP), with spectral analysis of the common, external and internal carotid artery, which localised the bifurcation with respect to the angle of the mandible and calculated the extension and mor- phology of the plaque. After mapping (Figs. 1, 2), the procedures were carried out with an “aimed” longitu- Carotid endarterectomy with mini-invasive access in locoregional anaesthesia Alessandro De Troia 1 , Federico Mosso 1 , Lukla Biasi 1 , Piero Corona 1 , Tiziano Tecchio 1 , Matteo Azzarone 1 , Giuseppe Pedrazzi 2 , PierFranco Salcuni 1 1 Department of Surgical Sciences, Unit of Vascular Surgery, 2 Department of Public Health, Unit of Physics, University of Parma, Italy Abstract. Aim: To assess the validity of a carotid endarterectomy (CEA) with a mini-invasive access via a 3-7 cm cutaneous incision in locoregional anaesthesia as a viable alternative to the traditional access with a cutaneous incision longer than 7 cm. Materials and Methods: We carried out a retrospective analysis of 76 consecutive patients (Group A) who had undergone carotid CEA in locoregional anaesthesia with cervical mini-access (3-7 cm incision), compared to a preceding series of 95 patients (Group B) who had undergone the same operation through a traditional access (incision > 7 cm). All patients in Group A were examined solely by means of duplex ultrasound scanning. Results: No mortality occurred in Group A and the mor- bidity rate was as follows: 1.3% strokes, 2.6% minor neurological events and 6.5% transitory deficit of pe- ripheral nerves. In Group B, the mortality rate was 1%, with the following morbidity rate: 2% strokes, 1% minor neurological events and 7.3% transitory deficit of peripheral nerves. Statistical analysis revealed the two groups as being compatible for age, sex, associated pathologies and type of surgery. No statistically sig- nificant differences emerged between the two series of patients with regards to neurological morbidity or operative mortality. Conclusions: In addition to being more aesthetically pleasing, mini-invasive access is a viable alternative to the traditional access for patients undergoing carotid CEA in locoregional anaesthesia. (www.actabiomedica.it) Key words: Carotid endarterectomy, mini-incision, locoregional anaesthesia O R I G I N A L A R T I C L E ACTA BIOMED 2008; 79: 123-127 © Mattioli 1885