Patch angioplasty reduces morbidity and restenosis following carotid endarterectomy

Abstract

Abstract Background The role of patch angioplasty in the prevention of stroke and restenosis following carotid endarterectomy remains controversial, partly because of confounding variables such as surgical expertise and selective shunting. Methods A consecutive series of 177 carotid endarterectomies performed on 168 patients by, or under the supervision of, one surgeon between December 1992 and July 1999 with routine shunt insertion and completion arteriography was studied. Until April 1997 arteriotomies were closed primarily, with patch angioplasty reserved for small vessels or patients found to have occlusion of the internal carotid artery at operation. After April 1997 Dacron patch closure was performed routinely. All patients had duplex ultrasonography 3 months following endarterectomy. Results The indication for surgery and patient characteristics were similar in those who had primary closure and those with patch angioplasty. The postoperative morbidity and incidence of restenosis is shown in the Table. One of two patients found at surgery to have a recently occluded internal carotid artery had a stroke. The only patient with patch angioplasty and postoperative reocclusion had the lupus anticoagulant and reported amaurosis. Two wound infections overlying Dacron patches resolved with antibiotics and there were no episodes of patch disruption. Conclusion This study provides further evidence that patch angioplasty following carotid endarterectomy may reduce postoperative morbidity and early restenosis.