LONG-TERM FOLLOW-UP FOR RECURRENT STENOSIS - A PROSPECTIVE RANDOMIZEDSTUDY OF EXPANDED POLYTETRAFLUOROETHYLENE PATCH ANGIOPLASTY VERSUS PRIMARY CLOSURE AFTER CAROTID ENDARTERECTOMY

Purpose: To determine the effect of primary closure (PC) versus expand ed polytetrafluoroethylene patch graft angioplasty (PGA) on the incide nce of recurrent stenosis (>50% lumen diameter narrowing) after caroti d endarterectomy (CEA), 87 patients undergoing 100 consecutive CEA wer e prospectively randomized into two groups. Methods: Forty-four patien ts underwent 51 PC, and 43 patients underwent 49 PGA. All patients wer e evaluated after operation by duplex scanning at 1.5, 12, 24, and 36 months. There were no significant differences in the demographic chara cteristics or operative indications for CEA between the two patient gr oups. Complete follow-up was achieved in 86% (75/87) of the patients d uring the 36-month surveillance period. Results: The perioperative per manent neurologic morbidity in the PC and PGA groups was noted to be 4 % and 2%, respectively (PC = 2/51 vs PGA = 1/49, p = 0.58). Three addi tional reversible cerebral ischemic events occurred in the postoperati ve period (PC = 2/51 vs PGA = 1/49, p = 0.58). Other morbidity include d immediate postoperative hemorrhage requiring reexploration (1/51) in the PC group and an infected expanded polytetrafluoroethylene patch r equiring removal and replacement with autogenous vein (1/49). Long-ter m follow-up detected a single patient with significant bilateral reste noses of his primarily closed carotid arteries. None of the patients i n the PGA group had restenoses (PC = 2/51 vs 0/49, p = 0.50). In addit ion, no postoperative dilation of the common or internal carotid arter ies or perioperative death was observed. Conclusions: In patients unde rgoing CEA, these data demonstrate no significant difference in the pe rioperative morbidity or mortality between PC and PGA. Use of the patc h did not engender patients to patch rupture or aneurysmal degeneratio n as previously described with vein patch angioplasty procedures. This series supports effective use of either technique to achieve minimal rates of restenosis.