A prospective randomized study on bilateral carotid endarterectomy: Patching versus eversion

Objective To compare the clinical outcome and restenosis incidence of patie nts who underwent carotid endarterectomy with patch closure (CEAP) on one s ide and carotid eversion endarterectomy (CEE) on the other. Summary Background Data Although a few investigators have compared the resu lts of CEAP versus GEE, no reports have compared the outcome of CEAP versus CEE in the same patient. Methods Eighty-six patients were randomly selected for sequential surgical treatment involving either CEAP/CEE or CEE/CEAP. All patients underwent pos toperative duplex ultrasound study and clinical follow-up at 1, 6, and 12 m onths and every year thereafter. Various factors were analyzed to ascertain any association with restenosis, and Kaplan-Meier analysis was used to est imate the risk of restenosis. Results Demographic and clinical data were similar in the CEAP and CEE grou ps. The selective shunting rate was statistically higher in the CEAP group. There were no perioperative deaths. Although the incidence of perioperativ e ipsilateral stroke was not significant, CEAP patients had a rate of combi ned transient ischemic attacks and strokes that approached statistical sign ificance. The mean follow-up was 40 months. CEAP patients had a significant ly higher incidence of restenosis and combined occlusive events and resteno ses. Kaplan-Meier analysis showed that CEE had a significantly better cumul ative patency rate than CEAP and that freedom from restenoses at 24 and 36 months was 87% and 83% for CEAP and 98% and 98% for CEE, respectively. Conclusions CEE is less likely to cause perioperative neurologic complicati ons and restenoses than CEAP. The significantly higher rate of unilateral r ecurrence suggests that local factors play a more important role than syste mic factors in the occurrence of restenosis.