A Single-center Retrospective Study with 5- and 10-year Follow-up of Carotid Endarterectomy with Patch Graft

Abstract

Carotid endarterectomy (CEA) is widely used for cervical artery stenosis. In Japan, primary closure after endarterectomy has been a standard technique. Recently, the patch closure has been shown to be superior to the primary suture for the prevention of restenosis and ipsilateral stroke. This study evaluated the 5- and 10-year outcomes following CEA with patch graft closure in our institution. Between January 2000 and March 2013, 134 patients, who underwent CEA with patch graft closure were investigated in the current retrospective study. Among these patients, 102 CEAs in 97 patients were followed up for 5 years and 66 CEAs in 61 patients were for 10 years after the procedure. Restenosis was defined as >50% recurrent luminal narrowing at the endarterectomy site. In 5 years, symptomatic restenosis exhibited minor stroke in one patient at 58 months after CEA (restenosis rate 1.0%). The ipsilateral minor stroke occurred in three patients including the above case (2.9%). In 10 years, asymptomatic restenosis occurred in three patients in addition to the above symptomatic case (restenosis rate 6.1%), and the ipsilateral minor stroke occurred in four patients (6.1%). Carotid endarterectomy with patch graft exerted a high protective effect from restenosis up to 5 and 10 years in our institution. The number of carotid artery stenting is increasing all over the world but we speculated that the established surgical procedure of patched CEA prevented restenosis and ipsilateral stroke.

<p>Inhibitory Effect of Curcumin on Artery Restenosis Following Carotid Endarterectomy and Its Associated Mechanism in vitro and in vivo</p>

“…Previous studies have shown that approximately 5-15% of patients with carotid artery stenosis experience restenosis following CEA. 4,5 Although the detailed mechanisms are yet to be determined, it is generally believed that the pathological proliferation and inflammatory responses of vascular smooth muscle cells (VSMCs) can potentially contribute to atherosclerosis and arterial restenosis. 6,7 Therefore, the inhibition of the proliferation of VSMCs and the reduction of the occurrence of restenosis following CEA has become a major research focus.…”

A technique for reconstruction of a giant extracranial internal carotid artery aneurysm: A technical note

“…Moreover, the need for antiplatelet therapy in the perioperative period is considered a disadvantage of patch-based surgery. [11] In cases where end-to-end anastomosis is difficult due to insufficient carotid artery length, revascularization using autologous or artificial vessel grafts after aneurysm resection is used. [21] Garg et al [2] reported a reconstruction using a saphenous vein rather than an artificial vascular graft.…”

Comparison of Single and Dual Monitoring during Carotid Endarterectomy

“…We have reported details of the surgical maneuver for CEA in other articles. 21 , 22) In terms of using an internal shunt, if SSEP or SSEP+MEP showed a significant change at the time of clamping of the distal ICA, we initially asked the anesthesiologist to elevate systolic ABP up to 20–30% of the preoperative ABP. If the neuromonitor remained unimproved despite this increase in BP, we inserted the internal shunt immediately.…”