Introduction: In patients with symptomatic or asymptomatic severe internal carotid artery stenosis, carotid endarterectomy (CEA) reduces risk for stroke. The optimal surgical technique remains subject of debate. Our previous study based on perioperative results within 30 days after surgery showed no difference in complication rate comparing primary closure or patch angioplasty when used in selected patients.1This follow-up study aimed to assess long-term complication rate and restenosis after CEA with selective patching. Methods: Two hundred thirteen consecutive CEAs over a 3-year period from January 5th 2011 to December 19th 2013 were prospectively analyzed in a follow-up study over 5 years (mean 4.6, range 3.17-6.17). Postoperative risk factors and symptoms of cranial nerve injury, transient ischemic events, cerebrovascular events and mortality were evaluated. Duplex ultrasound was performed by a radiologist blinded to operative technique to evaluate patency of the carotid artery. Mann-Whitney U test was used to compare both group. Risk differences were calculated with 95% confidence intervals using Newcomb's method. Kaplan-Meier estimates of survival were plotted for 1-year and 5-year survival. The log rank test was used to compare survival between both groups (superiority test). Results: Patient population consisted of 141 males and 72 females with mean age 73 years at the time of surgery (SD 8.57, range 53-95). There was a follow-up of 89%. Primary closure was used in 110 operations, and patch angioplasty in 103 procedures (Dacron patch). Primary closure was performed when the carotid artery had a diameter above 5 mm, when there was a high carotid bifurcation or when the contralateral carotid artery was occluded. There were no significant differences among groups' baseline characteristics at the time of surgery. Primary closure was performed significantly more in male patients (P= .02). Overall complication rate postoperatively was 3.76% (1.8% after primary closure, 5.8% after patch angioplasty) and after 5 years 5.29% (2.0% after primary closure, 9.1% after patch angioplasty). These results are not significantly different between the two groups (P= .09 and P= .05). Four patients experienced cranial nerve damage postoperatively, two in each group. In each group one of the two fully recovered and the other had persistent complaints (P= 1). Complications during the 5-year follow-up period are summarized in Table 1. In the group of primary closure there was a mortality of 26 patients (23.6%) compared to 26 (25.2%) patients after patch angioplasty (P = .70; Figure 1). Objective duplex ultrasound showed no significant difference comparing restenosis in both groups (P= .43). Twelve patients showed a restenosis between 50-70% (6 primary closure; 6 patch angioplasty), none of the patients had high restenosis > 70%. Patient characteristics did not show a significant effect on long-term outcome. There was a correlation between postoperative use of antihypertensive medication and long-term stroke (P= .006), restenosis (P= .01) and mortality (P= .003). Conclusion: After long-term follow-up we found primary closure and patch angioplasty to be equivalent with respect to complication rate and restenosis when used in selected patients. Best medical treatment and especially the use of antihypertensive medication should be emphasized. Disclosure: Nothing to disclose