CAROTID-ARTERY SURGERY - ENDARTERECTOMY W ITH PATCH

Introduction Carotid patching after carotid endarterectomy remains a s ubject of controversy. However the recent medical literature shows tha t carotid patching lowers the incidence of both residual stenosis and early restenosis. Carotid patching seems also to lower the incidence o f postoperative carotid occlusion. Some authors advocate systematic pa tching, others recommend a more selective use of carotid paching, amon g patients with small caliber carotid artery and among those with rest enosis. Study We have realized this study to determine (1) the inciden ce of restenosis after direct closure in patients with internal caroti d artery of more than 3,5 mm internal diameter, (2) the adequate size of the patch in carotid arteries of less than 3,5 mm interval diameter (3), the adequate material to use for carotid patching. To answer thes e questions, we have done a prospective study of 188 carotid endartere ctomy comparing direct closure (Group A), saphenous patch (Group B), a nd prosthetic Gore-Tex patch (Group C) with randomization between saph enous and prosthetic patch. Results In this study we were unable to sh ow any difference among the three groups concerning postoperative mort ality and neurologic complications. However we have been able to show more residual stenosis in group A than in groups B and C. One saphenou s patch rupture occurred in Group B. After one year follow-up, five ou t of 43 restenosis occurred in Group A (11,6 %). The rate of restenosi s in groups B and C was 1,5 % (2/135). In group B, six patients (8,7 % ) had a dilatation of the saphenous patch of more than 50 % of their i nitial diameter. Conclusions In this study, carotid patch seems to low er the incidence of residual stenosis and early restenosis in small di ameter internal carotid arteries. Carotid patching with a 5 mm diamete r PTFE patch seems to be the ideal choice after carotid endarterectomy . Furthermore, prosthetic patching carry no risk of dilatation or rupt ure and spare the saphenous vein.