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Abstract

Obadia et al. have presented an interesting idea of using superior thyroid artery for patch angioplasty when carotid endarterectomy is performed under local-regional anesthesia. Their initial results with 58 operations during the year are excellent: no postoperative strokes and no evidence of early recurrent stenoses. Our study demonstrated that postoperative neurologic complications and late ipsilateral stroke, regardless of method of arterial closure, were not statistically different. Recurrent carotid stenosis, however, in general, is a “late” phenomenon, and this was reemphasized by our study, as recurrent stenosis in all patient groups occurred late (i.e., 24 to 60 months after operation). We await, and encourage, long-term follow-up on these patients operated on by Dr. Obadia's group for assessment of recurrent carotid stenosis. Although patch angioplasty in our study was not statistically superior to primary closure in preventing recurrent stenosis, it appears to be appropriate in habitual smokers and patients with small internal carotid arteries, most of whom are women. Until a large multicenter randomized trial answers the question of which is the most appropriate means to close the carotid artery after endarterectomy, a technically perfect operation appears to be the surest means of reducing the incidence of perioperative stroke, late ipsilateral stroke, and recurrent stenosis.