Long-term Outcomes of Carotid Reconstructions with Patch Angioplasty


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Abstract

Relevance The number of ischemic stroke (IS) has been increasing every year. Large investigations world wide have proved the effectiveness of carotid endarterectomy (CEA) in IS prevention for patients with significant atherosclerotic carotid artery (CA) lesions. Many authors got superior results after closing arteriotomy site with patch during CEA. This article is a continuation of early published in this journal “Short-term outcomes of carotid endarterectomies using different types of patch materials” (Vol.IV, №1 2011). The purpose of the study To analyze the long-term results of using different patches at CEA, to determine the indications for the use of a plastic material. Materials and methods In presented investigation long-term outcomes of carotid reconstructions with patch angioplasty have been analyzed. Patches were made of polytetrafluoroethylene (PTFE) and great saphenous vein (GSV) fragment from the hip. We formed two groups – the first group consists of 110 patients, they underwent 113 CEA with PTFE patch plasty. The second one combined 82 patients (83 CEA, autologous vein patch). Statistically groups were similar by concomitant diseases. The analyzed period of longterm outcomes was for the first group 38 months, for the second – 43 months. Results and their discussion The main cause of death in both groups was cardiac infarction (9,7% vs 8,4%, P>0,05). Lethality from IS at operation site was statistically comparable: 2.7% after CEA with PTFE patch angioplasty and 1,2% if autologous vein patch has been used, P>0,05. Consequences of non-lethal IS in the ipsilateral hemisphere were found after 3,5% and 1,2% cases accordingly, P>0,05. Hemodynamically significant CA restenosis (>60%) was registered after 1,2% CEA with saphenous vein patch; 8,9% patients with PTFE patch had this complication (3,5% – CA occlusion), P<0,05. Conclusion CEA’s with patch angioplasty demonstrate durable outcomes in long-term period. The results didn’t find any statistically significant difference in frequency of ipsilateral lethal and non-lethal strokes. Risk of hemodynamic significant carotid artery restenosis was higher in patients with PTFE patch angioplasty rather than using autologous vein patch.

About the authors

Chelyabinsk State Medical Academy, Chelyabinsk, Russian Federation

Author for correspondence.
Email: author@vestnik-surgery.com
Doctor of Medicine, Professor, Vice-rector of medical care, Head of department of surgery, faculty of postuniversity and continuous professional education Chelyabinsk State Medical Academy, Honored Doctor of Russian Federation

Chelyabinsk State Medical Academy, Chelyabinsk, Russian Federation

Email: k_andrey1986@mail.ru
post-graduate student, department of surgery, faculty of post-university and continuous professional education Chelyabinsk State Medical Academy

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