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Background Multiple studies have been conducted that demonstrate the superiority of patch angioplasty over primary closure for carotid endarterectomy (CEA). Patch angioplasty with poly-tetrafluorethylene patches (ACUSEAL) have shown results comparable to patch angioplasty with saphenous vein and polyester patches. This is a prospective randomized study to compare the clinical outcomes of CEA using ACUSEAL versus bovine pericardium patching (Vascu-Guard). Methods Two hundred patients were randomized (1:1) to either ACUSEAL or Vascu-Guard patching. Demographic data/clinical characteristics were collected. Intraoperative hemostasis times and the frequency of reexploration for neck hematoma were recorded. All patients received immediate and 1-month postoperative duplex ultrasound studies, which were repeated at 6-month intervals. A Kaplan–Meier analysis was used to estimate the risk of restenosis and the stroke-free survival rates. Results The demographics were similar in both groups, except for a higher incidence of current smokers in the ACUSEAL group and more patients with congestive heart failure in the Vascu-Guard group (P = 0.02 and 0.03, respectively). The mean operative internal carotid artery diameter and the mean arteriotomy length were similar in both groups. The mean hemostasis time was 4.90 min for ACUSEAL patching vs. 3.09 min for Vascu-Guard (P = 0.027); however, the mean operative times were similar for both groups (ACUSEAL 2.09 hr vs. Vascu-Guard 2.16 hr, P = 0.669). The incidence of reexploration for neck hematoma was higher in the Vascu-Guard group; 6.12% vs. 1.03% (P = 0.1183). The incidence of perioperative ipsilateral neurologic events was 3.09% for ACUSEAL patching vs. 1.02% for Vascu-Guard patching (P = 0.368). The mean follow-up period was 15 months. The respective freedom from ≥70% carotid restenosis at 1, 2, and 3 years were 100%, 100%, and 100% for ACUSEAL patching vs. 100%, 98%, and 98% for Vascu-Guard patching (P = 0.2478). The ipsilateral stroke-free rates at 1, 2, and 3 years were 96% for ACUSEAL and 99% for Vascu-Guard patching. Conclusions Although CEA patching with ACUSEAL versus Vascu-Guard differed in hemostasis time, the frequency of reexploration for neck hematomas was more frequent in the pericardial patch group; however, only 1 patient had documented suture line bleeding and the surgical reexploration rate is not likely to be patch related. There were not any significant differences in perioperative/late neurologic events and late restenosis in the 2 groups.

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“…Carotid artery occlusion was reported in 6% of those with standard Hemashield vs. 0% with PTFE patching. 16,17 …”

Section: Discussionmentioning

confidence: 99%

“…Two hundred CEA patients were consented in 28 months and randomized into 100 CEAs with ACUSEAL and 100 CEAs with Vascu-Guard patch, similar to previous studies conducted at our institution. 17–19 …”

Section: Methodsmentioning

confidence: 99%

Prospective Randomized Trial of ACUSEAL Versus Vascu-Guard Patching in Carotid Endarterectomy

Stone

AbuRahma

Mousa

et al. 2014

Annals of Vascular Surgery

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“…Необходимость в использовании пластического материала возникла после анализа долгосрочных результатов операций с использованием метода линейной пластики. Многочисленные сообщения разных авторов о высокой частоте рестенозов [14,17,19] заставили хирургов применять расширяющую заплату для закрытия артериотомного доступа [5,14,15,17].…”

Section: результатыunclassified

“…Главной проблемой при использовании синтетических материалов остается их повышенная тромбогенность и, как следствие, относительно высокая частота ранних тромбозов, периоперационных инсультов и поздних рестенозов [5,14,16]. Для пластики сонных артерий нами использована заплата из ксеноперикарда, обработанная эпоксисоединениями, также синтетическая заплата из ПТФЭ.…”

Section: результатыunclassified

“…Распространенной методикой КЭ является операция с использованием различных видов расширяющей заплаты (дакрон, ПТФЭ, ксеноперикард, аутовена и др.). Причем разные авторы приводят неоднозначные данные при сравнении использования того или иного материала заплаты [14][15][16][17].…”

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Immediate and long-term outcomes of carotid bifurcation remodeling

Karpenko¹,

Starodubtsev²,

Ignatenko³

et al. 2015

Patol krovoobrashch kardiokhir

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Immediate and long-term outcomes of carotid endarterectomy (CEA) performed in 363 patients at 6 months to 4 years are presented. It was found out that when using a xenopericardial patch, the occurrence of carotid artery restenosis is significantly lower if compared with the application of a PTFE patch. In comparison with classical CEA (carotid plasty with a xenopericardial patch and PTFE), eversion CEA and CEA with autoarterial bifurcation remodeling have a significantly lower frequency of restenosis (p<0,01) during long-term follow-up.

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Abstract: PTFE patching was superior to Hemashield in lowering the incidence of postoperative ipsilateral strokes and late recurrent stenosis.

Cited by 2 publications

References 0 publications

Prospective Randomized Trial of ACUSEAL Versus Vascu-Guard Patching in Carotid Endarterectomy

Prospective Randomized Trial of ACUSEAL Versus Vascu-Guard Patching in Carotid Endarterectomy

Immediate and long-term outcomes of carotid bifurcation remodeling

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