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Evidence summaries

Patch Angioplasty Versus Primary Closure for Carotid Endarterectomy

Carotid patch angioplasty may reduce the risk of stroke or death compared to primary closure in patients undergoing carotid endarterectomy. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 10 studies with a total of 1 967 subjects undergoing 2 157 operations. Follow up varied from hospital discharge to 5 years. Carotid patch angioplasty was associated with a reduction in the risk of ipsilateral stroke during the perioperative period (OR 0.31, 95% CI 0.15 to 0.63, 7 studies, n=1201) and long-term follow up (OR 0.32, 95% CI 0.16 to 0.63, 6 studies, n=1141). It was also associated with a reduced risk of perioperative arterial occlusion (OR 0.18, 95% CI 0.08 to 0.41, 7 studies, n= 1435), and decreased restenosis during long-term follow up (OR 0.24, 95% CI 0.17 to 0.34, 8 studies, n= 1719). Very few arterial complications, including haemorrhage, infection, cranial nerve palsies and pseudo-aneurysm formation were recorded with either patch or primary closure. No significant correlation was found between use of patch angioplasty and the risk of either perioperative (RR 0.62, 95% CI 0.18 to 2.09; 9 studies, n=1869) or long-term (RR 0.78, 95% CI 0.54 to 1.12; 7 studies, n=1332) all-cause death rates. There was a statistically non-significant decrease in any stroke or death during the perioperative period (OR 0.58, 95% CI 0.33 to 1.01; 8 studies, n= 1769), and a significant decrease during long-term follow-up (OR 0.59, 95% CI 0.42 to 0.84; 6 studies, n=1019).

Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment and blinding, and inadequate intention-to-treat adherence) and by imprecise results (few outcome events).

    References

    • Rerkasem K, Rothwell PM. Patch angioplasty versus primary closure for carotid endarterectomy. Cochrane Database Syst Rev 2009;(4):CD000160. [PubMed]

Primary/Secondary Keywords