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Meta-Analysis
. 2009 Oct 7;2009(4):CD000160.
doi: 10.1002/14651858.CD000160.pub3.

Patch angioplasty versus primary closure for carotid endarterectomy

Kittipan Rerkasem  1 , Peter M Rothwell
Affiliations
Meta-Analysis

Patch angioplasty versus primary closure for carotid endarterectomy

Kittipan Rerkasem et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Carotid patch angioplasty (with either a venous or a synthetic patch) may reduce the risk of carotid artery restenosis and subsequent ischaemic stroke. This is an update of a Cochrane Review originally published in 1995 and previously updated in 2004.

Objectives: To assess the safety and efficacy of routine or selective carotid patch angioplasty compared to carotid endarterectomy with primary closure.

Search strategy: We searched the Cochrane Stroke Group Trials Register (last searched 5 May 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2009), MEDLINE (1966 to November 2008), EMBASE (1980 to November 2008) and Index to Scientific and Technical Proceedings (1980 to November 2008). We handsearched journals and conference proceedings, checked reference lists, and contacted experts in the field.

Selection criteria: Randomised and quasi-randomised trials comparing carotid patch angioplasty with primary closure in any patients undergoing carotid endarterectomy.

Data collection and analysis: Two review authors independently assessed eligibility, trial quality and extracted data.

Main results: We included 10 trials involving 1967 patients undergoing 2157 operations. The quality of trials was generally poor. Follow up varied from hospital discharge to five years. Carotid patch angioplasty was associated with a reduction in the risk of ipsilateral stroke during the perioperative period (odds ratio (OR) 0.31, 95% confidence interval (CI) 0.15 to 0.63, P = 0.001) and long-term follow up (OR 0.32, 95%CI 0.16 to 0.63, P = 0.001). It was also associated with a reduced risk of perioperative arterial occlusion (OR 0.18, 95% CI 0.08 to 0.41, P < 0.0001), and decreased restenosis during long-term follow up in eight trials (OR 0.24, 95% CI 0.17 to 0.34, P < 0.00001). These results are more certain than those of the previous review since the number of operations and events have increased. However, the sample sizes are still relatively small, data were not available from all trials, and there was significant loss to follow up. Very few arterial complications, including haemorrhage, infection, cranial nerve palsies and pseudo-aneurysm formation were recorded with either patch or primary closure. No significant correlation was found between use of patch angioplasty and the risk of either perioperative or long-term all-cause death rates.

Authors' conclusions: Limited evidence suggests that carotid patch angioplasty may reduce the risk of perioperative arterial occlusion and restenosis. It would appear to reduce the risk of ipsilateral stroke and there is a non significant trend towards a reduction in perioperative any stroke rate and all-cause case fatality.

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Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 1 Any stroke: fatal and non‐fatal.
1.2
1.2. Analysis
Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 2 Stroke‐related death.
1.3
1.3. Analysis
Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 3 Stroke ipsilateral to endarterectomy site.
1.4
1.4. Analysis
Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 4 Death from all causes.
1.5
1.5. Analysis
Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 5 Any stroke or death.
1.6
1.6. Analysis
Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 6 Occlusion of the artery operated on.
1.7
1.7. Analysis
Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 7 Rupture/haemorrhage of endarterectomy site.
1.8
1.8. Analysis
Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 8 Infection of the endarterectomy site.
1.9
1.9. Analysis
Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 9 Cranial nerve palsy.
1.10
1.10. Analysis
Comparison 1 Patch versus no patch: perioperative complications < 30 days, Outcome 10 Complication with return to theatre.
2.1
2.1. Analysis
Comparison 2 Patch versus no patch: outcomes at end of follow up, Outcome 1 Any stroke: fatal and non‐fatal.
2.2
2.2. Analysis
Comparison 2 Patch versus no patch: outcomes at end of follow up, Outcome 2 Stroke‐related death.
2.3
2.3. Analysis
Comparison 2 Patch versus no patch: outcomes at end of follow up, Outcome 3 Stroke ipsilateral to endarterectomy site.
2.4
2.4. Analysis
Comparison 2 Patch versus no patch: outcomes at end of follow up, Outcome 4 Death from all causes.
2.5
2.5. Analysis
Comparison 2 Patch versus no patch: outcomes at end of follow up, Outcome 5 Any stroke or death.
2.6
2.6. Analysis
Comparison 2 Patch versus no patch: outcomes at end of follow up, Outcome 6 Restenosis/occlusion of the operated artery.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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References to other published versions of this review

Bond 2004
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