Sequential cohort study of Dacron patch closure following carotid endarterectomy.
BACKGROUND
Carotid endarterectomy reduces the risk of stroke and death in patients with severe carotid artery stenosis. This study examined whether the technique used to close the arteriotomy influenced the rate of perioperative transient ischaemic attack (TIA), stroke or death.


METHODS
A cohort of 236 patients undergoing carotid endarterectomy at a single centre was studied; 117 patients had primary closure of the arteriotomy and 119 patients in a sequential series had closure with a Dacron patch. A standard endarterectomy with completion intraoperative duplex imaging and digital subtraction angiography was used throughout.


RESULTS
Patch closure was associated with a significant reduction in the 30-day combined death, stroke and TIA rate: 10.3 per cent for primary closure versus 2.5 per cent for patch closure (P = 0.017). The risk of any cerebral event (stroke or TIA) was also significantly reduced (7.7 versus 1.7 per cent; P = 0.033). Residual stenosis on completion angiography was more common after primary closure (24.6 versus 7.4 per cent; P = 0.003).


CONCLUSIONS
Dacron patch closure had a higher technical success rate on completion imaging and was associated with a significant reduction in the risk of perioperative stroke, TIA and death.
Ali
T
T
Academic Department of Surgery, 1st Floor North Wing, St Thomas' Hospital, London SE1 7EH, UK. tahir.ali@kcl.ac.uk
Sabharwal
T
T
Dourado
R A
RA
Padayachee
T S
TS
Hunt
T
T
Burnand
K G
KG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000601:surgery*; D015331:Cohort Studies; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates / Q000627:therapeutic use*; D055502:Secondary Prevention; D020521:Stroke / Q000517:prevention & control*; D013526:Surgical Mesh; D016896:Treatment Outcome
D011093:Polyethylene Terephthalates