Carotid artery patch angioplasty: impact and outcome.
Our study objective was to determine if patch angioplasty after carotid endarterectomy decreases the incidence of post-reconstruction technical defects and recurrent stenosis. This was a retrospective review of a prospectively maintained database from February 1980 to February 2000. Main outcome measures included incidence of intraoperative technical defects, residual disease within 3 months of endarterectomy, and early/late carotid restenosis >50%. During the study period, 71% (1053) of patients had primary closure and 29% (435) had patch closure. Immediate post-reconstruction intraoperative imaging with angiography or duplex ultrasound was accomplished in all cases. Technical defects prompted the reopening of 136 (13%) carotid arteries closed primarily but only 9 (2%) of those that were patched (p < 0.0001). There were no instances of residual disease in either group. Overall rate of recurrent stenosis was 2%, 3%, and 3.5% at 5, 10, and 15 years, respectively by life-table analysis. Early and late restenosis was significantly reduced by patch angioplasty (p = 0.024 and 0.006, respectively). This study demonstrates that carotid artery patch angioplasty significantly reduces the incidence of detectable technical defects and the early/late recurrent stenosis rate.
Ballard
Jeffrey L
JL
Department of Surgery, Loma Linda University Medical Center, CA 92354, USA.
Romano
Matthew
M
Abou-Zamzam
Ahmed M
AM
Teruya
Theodore H
TH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000517:prevention & control / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex