Benefits of carotid patching: A randomized study

Abstract

Advocates of carotid artery patching claim a reduced incidence of recurrent stenosis after endarterectomy. A prospective study was undertaken to determine its value with random selection between primary closure and saphenous vein patching. A consecutive series of 129 carotid endarterectomies was evaluated by duplex scanning at 3, 6, and 12 months after operation. Intravenous digital subtraction angiography (DSA) was performed in the first postoperative days for control of the surgical technique and after 1 year to serve as a reference for the duplex scanning. Sixty-two patients were selected to have primary closure and 67 were chosen for the patching technique. Both groups were identical with regard to risk factors (mean age 63 years, 74% were men, 57% had hypertension, 41% had coronary disease, 37% had peripheral arterial disease, and 9% had diabetes mellitus), side of operation (55% left), symptoms (18% were asymptomatic), and postoperative DSA (81% were normal, 17% had residual lesions, and 2% had occlusions). A complete 1-year follow-up was obtained in 105 cases (81%); duplex scanning showed recurrent stenosis of more than 50% in 12 cases (11%). This was significantly higher after primary closure (10 of 48 patients = 21%) compared with patch closure (2 of 57 = 3.5%; p = 0.006) and also in women (6 of 25 = 24%) compared with men (6 of 80 = 7.5%; p = 0.03). Recurrent stenosis was present in 6 of 11 women with primary closure (55%), 4 of 37 men with primary closure (11%), 2 of 43 men with patching (5%), and none of 14 women with patch closure (0%).(ABSTRACT TRUNCATED AT 250 WORDS)

Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

“…22, 347 The rate may be reduced to <5% by use of patch angioplasty. 366,370 Rates of restenosis were reported in older trials to be higher after CAS than after CEA. In the SPACE trial, the rate of restenosis (≥70% luminal occlusion) was 10.7% for CAS compared with 4.6% for CEA after 2 years.…”

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive Summary

“…63,176,276 -281 Hemodynamically significant recurrent stenosis rates of 5% to 7% have been reported in multicenter trials. 62,176,276,[282][283][284][285][286][287][288][289][290][291][292][293][294][295][296][297][298][299] Data comparing restenosis after CEA and CAS must be interpreted cautiously because of selection bias and stent-generated artifacts in ultrasound velocity measurements. After 1 year of follow-up in the SPACE trial, 4.6% of patients who underwent CEA and 10.7% of those undergoing CAS had developed Ն70% recurrent stenosis as assessed by ultrasound (Pϭ0.0009).…”

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease

“…407,440,468,624,625,628 -630 When periodic duplex scanning is used, hemodynamically significant recurrent stenosis rates of 5% to 7% have been reported in multicenter trials in which the quality of surgery is monitored carefully. 396,403,404,406,440,628,[631][632][633][634][635][636][637][638][639][640][641][642][643][644][645] Recurrent carotid stenosis after CEA is a trimodal phenomenon. The first event is not really recurrence but instead represents an unsatisfactory or incomplete CEA.…”

“…Multiple comparative reviews have failed to demonstrate a consistent difference in outcomes with either technique compared with the other. [395][396][397][398][399][400][401][402][403][404][405] One report involved a single experienced surgeon and a series of patients who required staged bilateral CEA in whom 1 side was randomly allocated to primary closure and the other side to patch angioplasty. 406 Patch angioplasty was associated with lower 30-day surgical morbidity and mortality and fewer cases of residual or recurrent stenosis as assessed by periodic duplex scanning for up to 1 year postoperatively.…”