The role of patch angioplasty in prevention of early recurrent carotid stenosis

The aim of this study was to determine the effect of primary closure versus patch angioplasty on the incidence of early recurrent stenosis after carot id endarterectomy in the hands of a single surgeon, and to analyze the risk factors associated with early recurrent stenosis after carotid endarterect omy. A retrospective review was performed of 178 consecutive patients who u nderwent 200 carotid endarterectomies-100 done consecutively with primary c losure and 100 done consecutively with patch angioplasty. Of these patients , 126 qualified for analysis by having had at least 18 months of follow-up by serial duplex scanning. Of this group, the first 65 patients underwent 7 5 routine primary closures, while the last 61 underwent 67 routine patch an gioplasties. All patients underwent a completion angiogram at the end of th e case. Recurrent stenosis was defined as luminal diameter narrowing >60% o n duplex scan. A multifactorial analysis was performed to analyze the effec t of age, sex, tobacco use, diabetes, hypertension, peripheral vascular dis ease, coronary artery disease, and contralateral stenosis on recurrent sten osis. The results of this study showed that in a single surgeon's experienc e with carotid endarterectomy, varying only the method of closure between p rimary closure versus patch angioplasty, there is no statistically signific ant difference in the rate of early restenosis. No difference was noted in the perioperative morbidity and mortality between groups.