RANDOMIZED CONTROLLED TRIAL OF PATCH ANGIOPLASTY FOR CAROTID ENDARTERECTOMY

A randomized controlled trial was performed to evaluate patch angiopla sty for patients undergoing carotid endarterectomy. There were 213 pat ient episodes affecting 148 men and 65 women, with 109 allocated to pa tch angioplasty. Following surgery six patients suffered transient isc haemic attacks but these did not delay discharge fi om hospital. Six i ndividuals (four parched operations, two not patched) required re-expl oration for postoperative haemorrhage and eight (two patched procedure s, six not) had potentially serious neurological problems after operat ion. Of these eight patients, four (none receiving patch angioplasty) underwent re-exploration and in each case a clot was removed and a pat ch inserted; three of the four made a good long-term recovery. The oth er four patients suffered completed strokes from which one died. Two f urther patients (one patched procedure, one not) died after operation from myocardial events, giving an overall 30-day stroke or mortality r ate of 2.8 per cent. Objective follow-up assessment,vith duplex scanni ng at I year was completed by 94.8 per cent of patients; significantly more vessel restenoses and occlusions were observed in those not rece iving patches (P<0.01). Patch angioplasty reduces the number of immedi ate postoperative complications, and significantly lowers vessel reste nosis and occlusion rates at 1 year after operation.