PS80. Systematic Review of Randomized Controlled Trials of Patch Angioplasty Versus Primary Closure and Different Types of Patch Materials During Carotid Endarterectomy

Abstract

Patch angioplasty during carotid endarterectomy (CEA) may reduce the risk for perioperative or late carotid artery recurrent stenosis and subsequent ischemic stroke. We performed a systematic review of randomized controlled trials to assess the effect of routine or selective carotid patch angioplasty compared with CEA with primary closure, and the effect of different materials used for carotid patch angioplasty. Randomized trials during 1966-2009 were included if they compared carotid patch angioplasty with primary closure in any patients undergoing CEA or use of one type of carotid patch with another. Twenty-three eligible randomized trials were identified. Ten trials involving 2157 operations compared primary closure with routine patch closure, and thirteen trials with 2083 operations compared different patch materials. Patch angioplasty was associated with a reduction in risk for ipsilateral stroke during the perioperative period (p = 0.001), and long-term follow-up (p = 0.001). Patching was also associated with reduced risk for perioperative arterial occlusion (P <.0001) and decreased recurrent stenosis during long-term follow-up (p < 0.001). Seven trials that compared between vein and synthetic patches showed that apart from psudoanaeurysmal formation, there were no significant different in the outcome between vein patch and synthetic materials in either the short- or long-term. There were significantly fewer pseudoaneurysms associated with synthetic patches than vein patches (p = 0.005) Carotid patch angioplasty decreases the risk for both ipsilateral stroke in both perioperative and long-term risk. More data are required to establish differences between various patch materials.