Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun 15;4(2):e96-e101.
doi: 10.1055/s-0038-1655757. eCollection 2018 Apr.

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

Eline Huizing  1 , Cornelis G Vos  1   2 , Robin G Hulsebos  1 , Peter J van den Akker  1 , Gert Jan de Borst  3 , Çağdaş Ünlü  1
Affiliations

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

Eline Huizing et al. Surg J (N Y). .

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.

Keywords: carotid endarterectomy; ipsilateral stroke; patch angioplasty; patching; primary closure; restenosis.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest None.

References

    1. Ricotta J J, Aburahma A, Ascher E, Eskandari M, Faries P, Lal B K; Society for Vascular Surgery.Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease J Vasc Surg 20115403e1–e31. - PubMed
    1. Liapis C D, Bell P R, Mikhailidis Det al.ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques Eur J Vasc Endovasc Surg 200937(4, Suppl):1–19. - PubMed
    1. Naylor A R, Sayers R D, McCarthy M J et al.Closing the loop: a 21-year audit of strategies for preventing stroke and death following carotid endarterectomy. Eur J Vasc Endovasc Surg. 2013;46(02):161–170. - PubMed
    1. Bekelis K, Moses Z, Missios S, Desai A, Labropoulos N. Indications for treatment of recurrent carotid stenosis. Br J Surg. 2013;100(04):440–447. - PubMed
    1. Arquizan C, Trinquart L, Touboul P J et al.Restenosis is more frequent after carotid stenting than after endarterectomy: the EVA-3S study. Stroke. 2011;42(04):1015–1020. - PubMed