Outcome of selective patching following carotid endarterectomy

Golledge, Jonathan; Cuming, R.; Davies, Alun H.; Greenhalgh, R M

doi:10.1016/s1078-5884(96)80182-1

Cited by 34 publications

(28 citation statements)

References 13 publications

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“…6,8 -12,23-25 Others have suggested that the apparent benefit of patch angioplasty is most readily seen in the previously defined high-risk groups, which comprised patients with small arteries, female sex, or continued use of tobacco. 5,26 This present report suggests that patch angioplasty is beneficial to all groups since we were unable to demonstrate any specific risk factor that was associated with a higher incidence of recurrent carotid stenosis. Specifically, female sex, continued use of tobacco, and other factors, including hyperlipidemia, were not associated with an increased risk of recurrent stenosis in this study.…”

Section: Discussioncontrasting

confidence: 60%

Recurrent Carotid Stenosis

Moore

Kempczinski

Nelson

et al. 1998

Stroke

145

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for the ACAS InvestigatorsBackground and Purpose-We sought to determine the incidence of recurrent carotid stenosis in patients in the Asymptomatic Carotid Atherosclerosis Study (ACAS) who had undergone carotid endarterectomy and were prospectively followed with Doppler ultrasound for up to 5 years. Methods-The ACAS database was interrogated to determine the rate of recurrent carotid stenosis (Ն60%) based up angiogram-validated Doppler data, with a 90% and a 95% positive predictive value, as well as information concerning the technologists' interpretation of percent stenosis. These 3 parameters are reported for each of 3 time intervals: within 3 months of operation (residual disease), between 3 and 18 months (early restenoses), and between 18 and 60 months (late restenosis). Results-Of the 825 patients randomized to the surgical arm of the study, 720 actually underwent carotid endarterectomy, and 645 had complete ultrasound data. The aggregate incidence of residual and recurrent carotid stenosis for all time intervals ranged from 12.7% to 20.4%, depending on the positive predictive value confidence level desired. Residual disease occurred in 4.1% to 6.5%; true, early restenosis was found in 7.6% to 11.4%; and late restenosis occurred in 1.9% to 4.9%. None of the traditional risk factors showed a statistically significant effect on recurrent stenosis. The use of patch angioplasty closure reduced overall risk of restenosis from 21.2% to 7.1%, from 16.7% to 4.6%, and from 27.4% to 8.2%, depending on the PPV confidence level desired (PϽ0.001). Of the 136 patients judged to have recurrent stenosis, only 8 (5.9%) underwent reoperation (only 1 for symptoms). There was no correlation between late stroke and recurrent stenosis. Conclusions-Carotid endarterectomy is a durable procedure with a low rate of true restenosis, particularly when patch angioplasty is used to close the arteriotomy.

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Section: Discussioncontrasting

confidence: 60%

Recurrent Carotid Stenosis

Moore

Kempczinski

Nelson

et al. 1998

Stroke

145

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“…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.…”

Section: Technical Considerationsmentioning

confidence: 99%

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

Brott¹,

Halperin²,

Abbara

et al. 2011

Stroke

139

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“…The advantage of patch closure is visual confirmation of complete plaque removal, but the disadvantage is the greater length of time required for closure. 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).…”

Section: Technical Considerationsmentioning

confidence: 99%