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Patches of different types for carotid patch angioplasty
C Counsell1, C Warlow, R Naylor
1Neurosciences Trials Unit, Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh, UK, EH4 2XU. cpw@skull.dcn.ed.ac.uk
Background:
Some surgeons who use carotid patching favour using the saphenous vein, whilst others favour synthetic materials.
Objectives:
The objective of this review was to assess the effect of different materials for carotid patch angioplasty.
Search Strategy:
We searched the Cochrane Stroke Group trials register, Medline (1966 to 1995), Embase (1980 to 1995) and Index to scientific and technical proceedings (1980 to 1994). We handsearched Annals of Surgery (1981 to 1995), British Journal of Surgery (1985 to 1995), European Journal of Vascular and Endovascular Surgery (1987 to 1995) and World Journal of Surgery (1978 to 1995).
Selection Criteria:
Randomised trials comparing one type of carotid patch with another for carotid endarterectomy.
Data Collection And Analysis:
One reviewer applied the inclusion criteria and extracted the data. Trial quality was assessed.
Main Results:
Three trials involving 326 operations were included. The trials compared saphenous vein patches with synthetic polytetrafluroethylene patches. Allocation was not adequately concealed in two trials, and only one followed-up patients until hospital discharge. Intention-to-treat analysis was only possible for the latter trial. In all trials a patient could be randomised twice and have each carotid artery randomised to different treatment groups. One trial was excluded from the analyses of death and any stroke because it was not possible to clarify how many patients, rather than arteries, were allocated to each treatment. There were too few events to determine whether there was any difference between the patch materials for perioperative stroke, death and arterial complications. During longterm follow-up for more than one year, no difference was shown between the two types of patch for the risk of stroke, death, or arterial restenosis. However, the number of events was small. Based on 236 patients in two trials, there were significantly fewer pseudoaneurysms associated with synthetic patches (odds ratio 0.15, 95% confidence interval 0.05 to 0.44).
Reviewer'S Conclusions:
There is not enough evidence to differentiate between venous and synthetic patches in carotid endarterectomy.