Patch Angioplasty or Primary Closure Following Carotid Endarterectomy for Symptomatic Carotid Artery Stenosis

Abstract

Objectives Guidelines recommend routine patching to prevent restenosis following carotid endarterectomy, mainly based on studies performed many years ago with different perioperative care and medical treatment compared with current standards. Aim of the present study was to compare primary closure (PRC) versus patch closure (PAC) in a contemporary cohort of patients. Methods Consecutive patients treated by carotid endarterectomy for symptomatic stenosis between January 2006 and April 2016 were retrospectively analyzed. Primary outcome was restenosis at 6 weeks and 1 year and occurrence of ipsilateral stroke. Secondary outcomes were mortality, complications, and reintervention rates. Results Five hundred carotid artery endarterectomies were performed. Fifty-nine patients were excluded because eversion endarterectomy was performed or because they were asymptomatic. PRC was performed in 349 and PAC in 92 patients. Restenosis at 6 weeks was 6.0% in the PAC group versus 3.0% in the PRC group ( p = 0.200). Restenosis at 1 year was 31.6 versus 14.1%, respectively ( p = 0.104). No difference was found for stroke (3.4 vs 1.1%, p = 0.319), death (1.1 vs 0.0%, p = 0.584), or other complications (1.1 vs 0.0%, p = 0.584), respectively. Conclusions It remains unclear whether routine patching should be recommended for all patients. A strategy of selective patching compared with routine patching, based on internal carotid artery diameter and other patient characteristics, deserves further investigation.

Compransion Of The Clinical Outcomes Of Primary Closure And Patch Plasty Thecniques In Carotid Endarterectomy

“…[11,12] Therefore, the patchplasty is now considered to be the standard of practice for the patients undergoing conventional CEA. Although a previous meta-analysis revealed that the patch angioplasty was associated with lower restenosis and perioperative stroke rates, [13] a recent retrospective study performed by Huizing E et al [14] questioned this assumption. These authors suggested that, in patients with symptomatic CAS, there was no difference in PA and PC groups in terms of restenosis, stroke, or death rates.…”

“…These authors suggested that, in patients with symptomatic CAS, there was no difference in PA and PC groups in terms of restenosis, stroke, or death rates. [14] After this study, Huizing E et al [14] performed a meta-analysis based on moderate-quality trial data, and they found that perioperative stroke and restenosis rates were lower in the patients undergoing PA when compared to those undergoing PC. [15] The meta-analysis of Huizing E et al [14] confirmed the results of previous meta-analyses, in which the PA was deemed safer when compared to the PC technique.…”

“…[14] After this study, Huizing E et al [14] performed a meta-analysis based on moderate-quality trial data, and they found that perioperative stroke and restenosis rates were lower in the patients undergoing PA when compared to those undergoing PC. [15] The meta-analysis of Huizing E et al [14] confirmed the results of previous meta-analyses, in which the PA was deemed safer when compared to the PC technique. As we could not detect a difference regarding to restenosis and stroke rates between the two procedures, the results of the current study were not in agreement with the meta-analysis results of Huizing E et al [14] The lack of this difference might be due to the retrospective nature of the present study and a relatively small sample size.…”

Vascular Patches for Arterial Reconstruction, Challenges and Advanced Technologies

“…Также в исследовании с ретроспективным анализом результатов КЭА у 1737 пациентов, одной половине которых была осуществлена ангиопластика заплатой, а другой -первичным швом, не было обнаружено достоверных отличий по осложнениям в ранний и поздний послеоперационные периоды в зависимости от способа закрытия разреза [7]. Кроме того, Huizing и соавторы отмечали большую частоту рестенозов через 6 недель имплантации у пациентов с заплатой (6%) по сравнению с группой, в которой использовали первичное ушивание (3%) [8]. Похожую картину наблюдали и через год после операции с количеством случаев рестеноза в анализируемых группах 31,6% и 14,1% соответственно [8].…”

“…Кроме того, Huizing и соавторы отмечали большую частоту рестенозов через 6 недель имплантации у пациентов с заплатой (6%) по сравнению с группой, в которой использовали первичное ушивание (3%) [8]. Похожую картину наблюдали и через год после операции с количеством случаев рестеноза в анализируемых группах 31,6% и 14,1% соответственно [8].…”