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. 2010 Mar 17;2010(3):CD000071.
doi: 10.1002/14651858.CD000071.pub3.

Patches of different types for carotid patch angioplasty

Kittipan Rerkasem  1 , Peter M Rothwell
Affiliations

Patches of different types for carotid patch angioplasty

Kittipan Rerkasem et al. Cochrane Database Syst Rev. .

Update in

  • Patches of different types for carotid patch angioplasty.
    Orrapin S, Benyakorn T, Howard DP, Siribumrungwong B, Rerkasem K. Orrapin S, et al. Cochrane Database Syst Rev. 2021 Feb 18;2(2):CD000071. doi: 10.1002/14651858.CD000071.pub4. Cochrane Database Syst Rev. 2021. PMID: 33598915 Free PMC article.

Abstract

Background: Carotid patches for carotid endarterectomy may be made from an autologous vein or synthetic material.

Objectives: To assess the safety and efficacy of different materials for carotid patch angioplasty.

Search strategy: We searched the Cochrane Stroke Group trials register (last searched 3 August 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2009), MEDLINE (1966 to November 2008), EMBASE (1980 to November 2008) and Index to Scientific and Technical Proceedings (1980 to 2008). We handsearched relevant journals and conference proceedings, checked reference lists, and contacted experts in the field.

Selection criteria: Randomised and quasi-randomised trials comparing one type of carotid patch with another for carotid endarterectomy.

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

Main results: We included 13 trials involving a total of 2083 operations; seven trials compared vein closure with PTFE closure, and six compared Dacron grafts with other synthetic materials. In most trials a patient could be randomised twice and have each carotid artery randomised to different treatment groups. There were no significant differences in the outcomes between vein patches and synthetic materials apart from pseudoaneurysms where there were fewer associated with synthetic patches than vein patches (odds ratio (OR) 0.09, 95% confidence interval (CI) 0.02 to 0.49). However, the numbers involved were small and the clinical significance of this finding is uncertain. Compared to other synthetic patches, Dacron was associated with a higher risk of: perioperative combined stroke and transient ischaemic attack (P = 0.03); restenosis at 30 days (P = 0.004); perioperative stroke (P = 0.07) and perioperative carotid thrombosis (P = 0.1). During follow-up for more than one year, there were also significantly more strokes (P = 0.03), stroke/death (P = 0.02) and arterial restenoses (P < 0.0001) with Dacron but the numbers of outcomes were small and the significance of this finding is uncertain.

Authors' conclusions: The number of outcome events is too small to allow reliable conclusions to be drawn and more trial data are required to establish whether any differences do exist. Nevertheless, there is some evidence that other synthetic (e.g. PTFE) patches may be superior to collagen impregnated Dacron grafts in terms of perioperative stroke rates and restenosis. Pseudoaneurysm formation may be more common after use of a vein patch compared with a synthetic patch.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Perioperative events: synthetic versus vein (< 30 days), Outcome 1 Ipsilateral stroke.
1.2
1.2. Analysis
Comparison 1 Perioperative events: synthetic versus vein (< 30 days), Outcome 2 Any stroke.
1.3
1.3. Analysis
Comparison 1 Perioperative events: synthetic versus vein (< 30 days), Outcome 3 Death from all causes.
1.4
1.4. Analysis
Comparison 1 Perioperative events: synthetic versus vein (< 30 days), Outcome 4 Fatal stroke.
1.5
1.5. Analysis
Comparison 1 Perioperative events: synthetic versus vein (< 30 days), Outcome 5 Stroke or death.
1.6
1.6. Analysis
Comparison 1 Perioperative events: synthetic versus vein (< 30 days), Outcome 6 Arterial rupture.
1.7
1.7. Analysis
Comparison 1 Perioperative events: synthetic versus vein (< 30 days), Outcome 7 Cranial nerve palsy.
1.8
1.8. Analysis
Comparison 1 Perioperative events: synthetic versus vein (< 30 days), Outcome 8 Wound infection.
1.9
1.9. Analysis
Comparison 1 Perioperative events: synthetic versus vein (< 30 days), Outcome 9 Complication requiring further operation.
1.10
1.10. Analysis
Comparison 1 Perioperative events: synthetic versus vein (< 30 days), Outcome 10 Arterial occlusion.
1.11
1.11. Analysis
Comparison 1 Perioperative events: synthetic versus vein (< 30 days), Outcome 11 Wound haemorrhage.
2.1
2.1. Analysis
Comparison 2 Perioperative events: Dacron versus other synthetic patch (< 30 days), Outcome 1 Ipsilateral Stroke.
2.2
2.2. Analysis
Comparison 2 Perioperative events: Dacron versus other synthetic patch (< 30 days), Outcome 2 Any stroke.
2.3
2.3. Analysis
Comparison 2 Perioperative events: Dacron versus other synthetic patch (< 30 days), Outcome 3 Combined stroke and TIA.
2.4
2.4. Analysis
Comparison 2 Perioperative events: Dacron versus other synthetic patch (< 30 days), Outcome 4 Death from all causes.
2.5
2.5. Analysis
Comparison 2 Perioperative events: Dacron versus other synthetic patch (< 30 days), Outcome 5 Complication requiring further operation.
2.6
2.6. Analysis
Comparison 2 Perioperative events: Dacron versus other synthetic patch (< 30 days), Outcome 6 Arterial occlusion.
2.7
2.7. Analysis
Comparison 2 Perioperative events: Dacron versus other synthetic patch (< 30 days), Outcome 7 Early restenosis or occlusion.
3.1
3.1. Analysis
Comparison 3 Events during long‐term (> 1 year) follow‐up: synthetic versus vein, Outcome 1 Ipsilateral stroke.
3.2
3.2. Analysis
Comparison 3 Events during long‐term (> 1 year) follow‐up: synthetic versus vein, Outcome 2 Any stroke.
3.3
3.3. Analysis
Comparison 3 Events during long‐term (> 1 year) follow‐up: synthetic versus vein, Outcome 3 Death from all causes.
3.4
3.4. Analysis
Comparison 3 Events during long‐term (> 1 year) follow‐up: synthetic versus vein, Outcome 4 Fatal stroke.
3.5
3.5. Analysis
Comparison 3 Events during long‐term (> 1 year) follow‐up: synthetic versus vein, Outcome 5 Stroke or death.
3.6
3.6. Analysis
Comparison 3 Events during long‐term (> 1 year) follow‐up: synthetic versus vein, Outcome 6 Infection at endarterectomy site.
3.7
3.7. Analysis
Comparison 3 Events during long‐term (> 1 year) follow‐up: synthetic versus vein, Outcome 7 Arterial occlusions/restenosis > 50%.
3.8
3.8. Analysis
Comparison 3 Events during long‐term (> 1 year) follow‐up: synthetic versus vein, Outcome 8 Pseudoaneurysm formation.
4.1
4.1. Analysis
Comparison 4 Event during long‐term (> 1 year) follow‐up: Dacron versus other synthetic, Outcome 1 Ipsilateral stroke.
4.2
4.2. Analysis
Comparison 4 Event during long‐term (> 1 year) follow‐up: Dacron versus other synthetic, Outcome 2 Any stroke.
4.3
4.3. Analysis
Comparison 4 Event during long‐term (> 1 year) follow‐up: Dacron versus other synthetic, Outcome 3 Death.
4.4
4.4. Analysis
Comparison 4 Event during long‐term (> 1 year) follow‐up: Dacron versus other synthetic, Outcome 4 Stroke or death.
4.5
4.5. Analysis
Comparison 4 Event during long‐term (> 1 year) follow‐up: Dacron versus other synthetic, Outcome 5 Arterial occlusion/restenosis > 50%.
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References

References to studies included in this review

AbuRahma 1996 {published data only}
    1. AbuRahma AF, Khan JH, Robinson PA, Saiedy S, Short YS, Boland JP, et al. Prospective randomized trial of carotid endarterectomy with primary closure and patch angioplasty with saphenous vein, jugular vein, and polytetrafluoroethylene: perioperative (30 day) results. Journal of Vascular Surgery 1996;24:998‐1007. - PubMed
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References to studies excluded from this review

Carney 1987 {published data only}
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References to other published versions of this review

Bond 2004
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